Coronary artery disease is a leading cause of mortality and morbidity globally. The left coronary artery system is critically important due to its supply of a large area of myocardium. Ostia lesions of left anterior descending artery \[LAD\] and circumflex artery \[CX\]) present technical challenges during percutaneous coronary intervention (PCI) and are considered high-risk lesions due to their anatomical location, relationship with the left main coronary artery bifurcation. Two main approaches exist for treating these lesions: accurate ostial stenting and crossover stenting extending from the left main coronary artery to the relevant branch. Accurate ostial stenting aims to avoid unnecessary stenting of the left main coronary artery, while crossover stenting is more advantageous in terms of ensuring complete coverage of the ostial region. However, the crossover approach may have disadvantages such as larger stent implantation and potential side branch involvement. The current literature does not clearly define the clinical superiority of these two strategies. While various studies have shown no significant difference in mortality, myocardial infarction, and target lesion revascularization, the results are heterogeneous, and a definitive consensus has not been reached. The majority of current data are based on retrospective or observational studies. Therefore, well-designed prospective studies comparing crossover stenting and accurate ostial stenting strategies in the ostial left-sided coronary artery (LAD and CX) lesions are needed. This planned study aims to contribute to this gap in the literature by comparing the clinical outcomes of the two approaches.
Who can participate
Age range
18 Years – 85 Years
Sex
ALL
See this in plain English?
AI-rewrites the medical criteria so a patient or caregiver can understand them. Always confirm with the trial site.
Inclusion Criteria:
* Ostial left anterior descending artery or left circumflex artery disease
* Coronary intervention with second or third generation drug-eluting stent
Exclusion Criteria:
* Severe left main disease (≥30%, intravascular ultrasound plaque burden \>50%)
* History of coronary bypass grafting
* Cardiogenic shock
* Left main diameter greater than stent expansion capacity (for crossover group)
* In-stent restenosis
* End-stage liver or kidney disease (cirrhosis, hemodialysis-dependent chronic kidney disease),
* Coronary intervention with bare-metal stent
* Early discontinuation or inappropriate use of DAPT treatment
* Patients lost to follow-up
* Patient life expectancy \<1 year (such as cancer)
Questions worth asking your doctor
Bring these to your next appointment. They're a starting point for a shared conversation — not a sign you qualify or a recommendation to enrol.
1This trial is comparing two specific stenting techniques — crossover versus accurate ostial PCI — for a very particular type of left main bifurcation lesion called Medina 0.0.1 or 0.1.0, so should I ask my interventional cardiologist whether my lesion actually matches that exact pattern before we even discuss this trial further?
2The trial is listed as 'active but not recruiting,' which means they're no longer enrolling new patients — does that mean this approach is something my doctor could still apply based on what's being learned, or does it close off any possibility of me being involved?
3Since this trial is measuring major adverse cardiac events as its primary outcome, what does that term actually include in this context — things like heart attack, repeat procedures, or death — and how does the risk profile of these two techniques compare to what's currently considered standard of care for my type of lesion?
4Left main coronary artery disease is considered high-risk territory, so how does my doctor feel about whether a stenting strategy alone is appropriate for me, versus being evaluated for bypass surgery, which is sometimes preferred for left main disease?
5Because the trial phase is listed as 'NA' rather than a numbered phase, what does that tell us about the level of evidence behind these two techniques, and is there enough existing data for my doctor to feel confident recommending one approach over the other for my specific situation?
Generated to help you prepare — always confirm anything about your own eligibility and care with the study team and your doctor.
Questions for the trial coordinator
The trial coordinator is the person who runs the study day to day. These cover the practical side — logistics, costs, and what taking part would actually mean for your life. The study team confirms whether you meet the criteria; these are questions to ask, not a sign you qualify.
1What does taking part actually involve week to week — how many visits, where, and how long does each one take?
2What costs are covered by the study, and what might I have to pay for myself, including travel, parking, or time off work?
3What happens during screening, and what happens if the study team confirms I don't meet the criteria after those tests?
4Who pays for the scans, blood work, and other tests the trial requires — the study, my insurance, or me?
5How will being in the trial affect my regular care, and will my own doctor stay informed and involved?
6Can I leave the trial at any point if I change my mind, and what would happen to my care if I do?
A starting point for the conversation — always confirm anything about your own eligibility, costs, and care with the study team and your doctor.
What they're measuring
1
Major adverse cardiac event
Timeframe: 12 months
Trial details
NCT IDNCT07596706
SponsorIstanbul Mehmet Akif Ersoy Educational and Training Hospital