Crossover vs Accurate Ostial PCI for Medina 0.0.1 and 0.1.0 Left Main Bifurcation Lesions

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.

NCT Number	NCT07596706
Lead Sponsor	Istanbul Mehmet Akif Ersoy Educational and Training Hospital Collaborators: Yalova training and research hospital, Mersin City Hospital, Van Training and Research Hospital, Başakşehir Çam & Sakura City Hospital, Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Trakya University, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul Training and Research Hospital, Medipol University, Samsun Education and Research Hospital, Kocaeli University, Abant Izzet Baysal University, Saglik Bilimleri Universitesi Gazi Yasargil Training and Research Hospital, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Bagcilar Training and Research Hospital, Ankara City Hospital Bilkent, Dicle University, Bursa Yuksek Ihtisas Training and Research Hospital, Haseki Training and Research Hospital, Ahi Evran University Education and Research Hospital, Ankara Etlik City Hospital, Izmir Bakircay University, Istanbul Medipol University Hospital, Kutahya City Hospital, Adiyaman University Research Hospital, Adana City Training and Research Hospital, Kosuyolu Heart Hospital, Ege University, Bursa City Hospital, Bilecik Seyh Edebali Universitesi, Siirt Training and Research Hospital, Hitit University
Conditions	Coronary Bifurcation Lesion, Coronary Artery Disease (CAD), Left Main Coronary Artery Stenosis
Enrollment	1,000 participants
Start Date	2026-05-12
Primary Completion	2027-09-01 (estimated)
Study Completion	2027-09-15 (estimated)
Updated on ClinicalTrials.gov	2026-07-09