Novel Precise Ostial and Bifurcation Stenting Using a Guide Extension Catheter: The Ostial Stenting With Guide...

Precise stenting of coronary ostial and bifurcation lesions remains technically challenging. A geographical miss can cause incomplete lesion coverage or excessive stent protrusion, compromising procedural outcomes. We developed a novel, streamlined approach utilizing a guide extension catheter, termed the Ostial Stenting with Guide Extension catheter Tip (OS-GET) technique, to enhance precision in stent placement. The OS-GET technique employs the distal tip of a guide extension catheter as a stable fluoroscopic landmark to achieve precise alignment of the proximal stent marker with the true coronary ostium. Stabilization by the guide extension catherter mitigates stent migration during balloon expansion, facilitating optimal positioning. This technique is feasible with a 6-Fr guiding system and is compatible with all contemporary stent platforms and guide extension catheters, offering high procedural versatility. This technique was applied in three representative cases: (1) left anterior descending artery (LAD) ostial stenting, (2) left circumflex artery ostial stenting with heavy calcification following intravascular lithotripsy, and (3) mid-LAD stenting distal to a large diagonal branch. In all interventions, OS-GET enabled precise stent deployment with full lesion coverage and without protrusion into the left main trunk or adjacent branches. Final angiography confirmed Thrombolysis In Myocardial Infarction (TIMI) 3 flow, while intravascular ultrasound demonstrated optimal expansion and apposition. The OS-GET technique represents a practical, reproducible, and versatile strategy for precise stent placement in complex ostial and bifurcated lesions.