Two Layers of Stent in the Ostial RCA: Strategy, Imaging, and PCI Decision Making

Ostial RCA disease can be one of the most unforgiving lesions in coronary intervention — especially when multiple layers of stent are already present.In this MurmurMD case discussion, Dr. Nyal Borges and Dr. Joe Walsh review a challenging PCI involving two layers of stent at the ostial right coronary artery, focusing on how imaging and careful technique guide treatment decisions.The discussion walks through the key procedural considerations in managing complex ostial stent anatomy, including:• Evaluating restenosis and mechanical issues in previously stented segments• Understanding the challenges of ostial RCA stent positioning• Using intravascular imaging to assess stent expansion and vessel anatomy• Managing overlapping or layered stent architecture• Planning intervention when additional metal may worsen long-term outcomes• Balancing lesion preparation with procedural risk• Recognizing technical pitfalls unique to ostial coronary diseaseThis case provides practical insights into how experienced operators approach complex ostial PCI with prior stent layers.🔔 Subscribe for more insights from interventional experts and real-world program builders.📱 Download the app: https://apps.apple.com/app/apple-store/id1586692687📺 Follow us on YouTube: https://www.youtube.com/channel/UCfrLYhAhliQ2ZvXinkDCZvAChapters:00:00 – Case introduction: ostial RCA with prior stents 00:40 – Angiographic review and lesion assessment 01:30 – Understanding the challenge of two stent layers 02:20 – Imaging evaluation and vessel sizing 03:20 – Strategy discussion for treating ostial restenosis 04:20 – Device and technique considerations 05:10 – Procedural outcome and imaging review 06:00 – Lessons from managing layered ostial stents#OstialRCA #ComplexPCI #IVUS #InStentRestenosis #InterventionalCardiology #CathLab #MurmurMD