Left Main-to-LAD Crossover Versus Focal Ostial Stenting for Isolated Medina 0,1,0 Ostial LAD Stenosis: A Retrospective Comparative Cohort Study

Objectives: To compare 12-month clinical and procedural outcomes associated with left main coronary artery (LMCA)-to-left anterior descending artery (LAD) crossover stenting (COS) versus focal ostial-only stenting (OS) in patients undergoing percutaneous coronary intervention (PCI) for isolated true ostial LAD lesions with Medina 0,1,0 anatomy. Methodology: This single-center retrospective observational cohort study included 275 consecutive patients undergoing PCI for isolated ostial LAD stenosis between January 2021 and December 2024. Patients were treated with either LMCA-to-LAD crossover stenting (COS; n=111) or focal ostial-only stenting (OS; n=164), according to operator judgment and anatomical considerations. The primary 12-month composite outcome was target lesion failure, comprising cardiac death, target-vessel myocardial infarction, and clinically driven target lesion revascularization. Results: At 12 months, the primary composite adverse outcome occurred in 7.2% (8/111) of patients undergoing COS compared with 16.5% (27/164) undergoing OS (OR 2.54, 95% CI 1.11–5.82; p=0.027). The association remained after penalized multivariable adjustment (aOR 2.17, bootstrap 95% CI 1.14–4.35; p=0.019) and propensity-score IPTW (OR 2.58, 95% CI 1.14–5.84; p=0.023). The ischemic MACE sensitivity endpoint occurred in 2.7% versus 14.0% of patients, respectively (OR 5.87, 95% CI 1.72–20.07; p=0.001). Acute side-branch compromise occurred more frequently with COS (12.6% vs. 5.5%; p=0.046), although bailout side-branch stenting was uncommon in both groups (1.8% vs. 1.2%; p=1.000). All-cause mortality did not differ significantly between groups (4.5% vs. 10.4%; OR 2.45, 95% CI 0.88–6.85; p=0.111). These values correspond to the outcome data reported in the revised manuscript. Conclusion: Among patients with isolated Medina 0,1,0 ostial LAD disease, LMCA-to-LAD crossover stenting was associated with fewer 12-month composite adverse events than focal ostial-only stenting after adjustment for measured confounders. Crossover stenting was associated with a higher frequency of acute side-branch compromise, although bailout side-branch stenting remained uncommon, and no statistically significant difference in all-cause mortality was observed. Given the retrospective, non-randomized design, these findings demonstrate associations rather than causal superiority and warrant confirmation in prospective multicenter studies.