Real-Time IVUS-Guided Precision Stenting of the Ostial Left Anterior Descending Artery

Accurate stent placement in ostial left anterior descending artery (LAD) lesions is challenging, as angiography alone often misidentifies the true ostial plane.

A 63-year-old woman with unstable angina and significant ostial LAD stenosis underwent percutaneous coronary intervention after declining surgery. Real-time intravascular ultrasound (IVUS) imaging from the ramus ostium was used to visualize the LAD ostial plane continuously while withdrawing the stent. Precise alignment of the proximal stent edge with the true ostium was achieved and confirmed by final IVUS, demonstrating adequate expansion and absence of left main protrusion.

Real-time IVUS guidance enables direct visualization of the carina, plaque edge, and ostial plane, facilitating accurate positioning and minimizing geographic miss.

Continuous IVUS visualization from a side branch provides a practical strategy for millimetric accuracy during ostial LAD stenting.