Real-Time IVUS Guided (RTIG) Ostial Stenting: A Step-by-Step Guide

Ostial coronary lesions can be challenging to manage and have higher rates of target lesion failure. We describe the novel technique of real-time intravascular ultrasound (IVUS)-guided stenting to optimize ostial stent placement.

The key steps are: 1) Wire the target vessel and side branch, and prepare the lesion based on IVUS appearances. 2) Deliver the stent in beyond the target vessel lesion. 3) Pass the IVUS catheter into the side branch. 4) Withdraw the stent to a near-ostial position angiographically. 5) Withdraw the IVUS transducer to where the ostium is visible. 6) Deploy the stent. 7) Withdraw the IVUS catheter first. 8) Postdilate the stent. 9) Take a final IVUS run and angiogram.

The technique requires at least a 7-F guide catheter and a 5-F IVUS catheter. The main learning curve is understanding the IVUS appearances of the stent delivery system.

Real-time IVUS guidance is an effective and teachable technique to allow accurate placement of ostial side branch stents.