Ostial Lesions are described as coronary ostial stenosis, is the occlusion of coronary ostium located within the first 3 mm from the beginning of the coronary artery.
Causes
Atherosclerosis
Diagnosis
- Angiography
Types
Aorto-ostial lesions
Aorto-ostial leisions
- Aorto-ostial coronary lesions (AOL) are defined as a stenosis within 3 mm of the right coronary artery (RCA) or left main coronary artery (LMCA)
- Aorto-ostial lesions commonly have a unique three-dimensional funnel-shaped morphology with a variable angle of takeoff of the coronary artery from the aorta
- The majority of the AOL are accompanied by diffuse coronary artery disease and cases of isolated AOL occur predominantly in females
- Aorto-ostial lesions were examined postmortem in victims of acute myocardial infarction (AMI), sudden death without pathological evidence of AMI and violent death.
Pre-procedural imaging
- CCTA
- IVUS Intra-procedural imaging:
- Integrated IVUS on stent delivery system
- Fusion of IVUS and CCTA with angiographic imaging
- Devices for imaging the aorto-ostial plane
Diagnosis and treatment
- Diagnosis and treatment of these lesions is challenging and procedural success and clinical outcomes are inferior to non-ostial lesions.
- Diagnosis of AOL may be missed on coronary angiography when contrast media is injected distal to the lesion due to deep intubation of the catheter into the vessel.
- Intravascular ultrasound (IVUS) is a useful tool for detailed analysis of the AOL anatomy
- Various debulking strategies advocated for optimizing the outcome of angioplasty in rigid AOL included directional atherectomy, rotational atherectomy , excimer laser and cutting balloons.
- Introduction of bare metal stents reduced acute procedural complications and re-stenosis rate compared to balloon angioplasty
Implantation of short stents and excessive instrumentation following deployment may lead to stent dislodgement and embolization to the aorta - Direct contact between the guiding catheter and the proximal edge stent struts may lead to longitudinal stent deformation.
"Dr. Sharath Reddy is the best cardiologist in Hyderabad. We underwent the heart treatment under him. We are very happy with the treatment."
I would like to thank Dr Sharath Reddy and his team for the excellent cardiac care and treatment provided to me. I have been given all the information and advice to lead my life in a comfortable way after the procedure. I can’t thank you enough for all your time, hard work, and patience. I truly appreciate your caring dedication.
My brother had severe dyspnoea (shortness of breath) and it was difficult for him to walk for even very small distances. He had severe pedal oedema (feet swelling) and was not able to do routine activities on his own. But after TAVI procedure he is able to breathe well and walk comfortably for small distances without any difficulty. Within a short time after the TAVI procedure he is performing his routine own activities. We are grateful to the cardiac team at Medicover Hospitals.
