The fluoroscopic IVUS X-mark IT (FIX-IT) technique: A reproducible, image-guided approach to ostial stent deployment

Ostial coronary lesions present significant technical challenges during percutaneous coronary intervention (PCI), where imprecise stent positioning can result in geographic miss, stent protrusion, or compromised future access. Angiographic guidance alone is often limited by vessel foreshortening, overlapping structures, and variable aortic root anatomy. Although intravascular ultrasound (IVUS) provides high-resolution visualization of the coronary ostium and plaque morphology, its integration into real-time ostial stent deployment has been inconsistent, partly due to equipment and technical constraints. The Fluoroscopic IVUS X-mark IT (FIX-IT) technique offers a simple, reproducible solution by using IVUS to identify the true anatomical ostium and translate this landmark precisely onto fluoroscopy. This facilitates accurate stent placement while minimizing contrast use and reducing the risk of geographic miss. We describe the application of FIX-IT for ostial left anterior descending (LAD) artery stenting across three different IVUS platforms, demonstrating its adaptability, procedural reliability, and potential to improve technical success and long-term outcomes in ostial PCI.