A Novel “Telescopic Locking” Technique for Precise Stent Placement in the Ostium of the Left Anterior Descending Artery

Approaching percutaneous coronary intervention (PCI) of ostial left anterior descending artery (LAD) lesions has always been a unique challenge. The proximity of the ostial LAD lesion to the left main coronary artery (LMCA) and to the origin of the left circumflex (LCX) has always made treating these lesions difficult. It is often difficult to correctly place stents at these locations due to many variables, such as respiratory variation, cardiac motion, suboptimal angiographic visualization; all of which could lead to improper placement, thereby leading to possible complications involving the LMCA or LCX. There are several techniques in literature that have aimed to improve stent accuracy in this location, however most of these can be technically demanding or could anatomically be difficult to do. In this paper we introduce a novel technique which we call the "telescopic locking" method, whereby we make use of a guide extension catheter as a radiopaque maker and mechanical backstop to aid precise stent positioning at the LAD ostium. We present two cases in this paper to illustrate this technique.