ArticleEuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology2025
Optimal minimal stent area after crossover stenting in patients with unprotected left main coronary artery disease.
Article in EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it.
- IVUS-Guided Versus Angiography-Guided PCI for Unprotected Left Main Coronary Artery Disease: A Systematic Review, Meta-Analysis, and GRADE Assessment of Randomized Trials.Clinical cardiology · 2026Pooled it
- Optical Coherence Tomography-Guided Versus Angiography-Guided PCI in Moderate-to-Severe Calcified Coronary Lesions: A Systematic Review and Meta-Analysis of Randomized Trials.Diagnostics (Basel, Switzerland) · 2026Review
- Evolving cutoff values for optimising left main stenting with intravascular imaging.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2025Article
- Regarding the OPTIMAL study: analyzing the apparent disconnect between a clinical trial and real-world practice.REC, interventional cardiologyArticle
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11 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundIntracoronary imaging-guided percutaneous coronary intervention (PCI) has demonstrated clinical benefit over angiography-guided PCI for left main coronary artery (LM) disease. However, the optimal minimal stent area (MSA) thresholds to predict cardiovascular outcomes remain incompletely defined.
aimsThis study aimed to evaluate intravascular ultrasound (IVUS)-measured segmental MSA after LM crossover stenting.
methodsWe identified 829 consecutive patients who underwent IVUS-guided PCI for unprotected LM disease using a single-stent crossover technique. The final MSA was measured at the proximal LM, distal LM, and left anterior descending artery (LAD) ostium. The primary outcome was 5-year major adverse cardiac events (MACE), including all-cause death, myocardial infarction, and target lesion revascularisation.
resultsThe MSA cutoff values best predicting 5-year MACE were 11.4 mm² for the proximal LM (area under the curve [AUC] 0.62), 8.4 mm² for the distal LM (AUC 0.58), and 8.1 mm² for the LAD ostium (AUC 0.57). Based on these cutoff values, stent underexpansion in the proximal LM was significantly associated with increased risk of 5-year MACE (adjusted hazard ratio [HR] 2.34; p<0.001). Additionally, patients with simultaneous stent underexpansion in both the distal LM and LAD ostium exhibited a significantly higher risk of 5-year MACE compared with those having adequate expansion or only single-site underexpansion (adjusted HR 2.57; p<0.001).
conclusionsAchieving sufficient stent expansion in the proximal LM and preventing underexpansion in both the distal LM and LAD ostium are critical for improving long-term clinical outcomes. The identified MSA thresholds may serve as practical benchmarks for stent optimisation during LM PCI.
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