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 disease

This case provides practical insights into how experienced operators approach complex ostial PCI with prior stent layers.

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Chapters:

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