Ostial Stent Implantation or Crossover Stenting for Ostial LAD Lesions: The Multicenter CROSS-ANATOLIA Registry

Abstract

Percutaneous coronary intervention (PCI) for isolated ostial left anterior descending artery (LAD) lesions remains technically difficult. Accurate ostial stenting (AOS) aims to prevent involvement of the left main coronary artery (LMCA), while crossover stenting (COS) ensures complete ostial coverage but may increase procedural complexity. This study aimed to evaluate the long-term outcomes of patients who underwent AOS or COS for ostial LAD disease. From 2014 to 2025, patients who underwent PCI for ostial LAD lesions were retrospectively collected. The primary outcome was major adverse cardiac events (MACE), including cardiac death, target lesion revascularization (TLR), and target vessel myocardial infarction (TVMI). This large-scale multicenter (n = 12) observational study included a total of 1,167 consecutive patients [men: 859 (73.6%), mean age: 61.70 ± 12.73 years] with ostial LAD lesions who underwent PCI; 590 (50.6%) of the cases were revascularized with AOS, and 577 (49.4%) were treated with COS. The incidences of MACE (18.1 vs 9.5%, p <0.001), TVMI (9.2 vs 4.7%, p = 0.003), and clinically driven TLR (10.7 vs 4.2%, p <0.001) were notably higher in the AOS group compared to the COS group. Treatment (AOS) (HR:2.469, p <0.001), chronic kidney disease (HR:1.832, p = 0.003), reduced LVEF (HR:1.016, p = 0.042), SYNTAX score (HR:1.089, p <0.001), lack of intravascular imaging (HR:1.451, p = 0.049), direct stenting (HR:2.171, p = 0.001), stent length (HR:1.036, p = 0.001) were found to be independent predictors of MACE. In conclusion, this nonrandomized study suggests that COS was associated with better long-term MACE, TVMI, and clinically driven TLR rates compared with AOS in patients with ostial LAD disease.

Keywords: accurate ostial stenting; crossover stenting; major adverse cardiac events; ostial lad lesion.