Ostial stenting is always a challenge whether it is stenting the ostial lad or it is stenting the ostial RCA or LMCA.

Accurate stent placement at the ostium is frequently hampered due to to and fro motion of the stent with cardiac motion. Various techniques have been described for accurate placement.

1 To and fro motion can be restricted it stopped by making the guide non coaxial.

2 If there is a landing zone, this suffices. However if there is no landing zone, decision of accurate ostial stenting vs crossover stenting head to be made.

Crossover stenting is of choice especially in ostial LAD location if

1 Angle is unfavorable

2 Disease extends into distal LM.

Accurate ostial stenting with a strut in the LM may be required if

1 Angle is favorable

2 there is a size mismatch

Ostial stenting can be performed by

1 accurate placement especially if there is a landing zone

2 Balloon inflation across the bifurcation to help localize the ostium

3 Szabo technique. Here both branches are wired and stent is loaded over the main branch wire and the side branch wire is threaded through the last straw m strut if the stent. This can be done by lifting the strut with a needle or by low pressure inflation inside the stent hub partially and recrimping.