Case 160: Manual of PCI - Blocking balloon

A patient presented with unstable angina. The culprit lesion was an LAD/diagonal bifurcation lesion. PCI with DK crush was performed. Rewiring the diagonal after deploying the LAD stent was challenging: using a polymer jacketed wire and a dual lumen microcatheter failed. We placed a balloon in the LAD immediately distal to the origin of the diagonal (deflection balloon technique). The deflection allowed advancement of a Sion black wire into the diagonal. Balloon and microcatheter advancement initially failed but subsequently succeeded using a deploy seated guide extension with a nice final result.

[@shangz0216]

Thanks for the educative case presentation.

[@hifa63]

Many thanks. Very useful

[@ahmedzahran7016]

Excellent case, Can I ask if the LM lesion needs further action and if such a lesion would affect the DPR value just like Aortic stenosis disrupts coronary physiology?

[@manosbrilakis]

No further action needed in the left main - there was no significant step up in the iFR pullback.

[@maisamtaherian986]

Thank you very much🌹 can we keep the blocking balloon and use it as an anchor to deliver equipment?

[@manosbrilakis]

Yes, absolutely

[@user-zg9ip4jp4e]

terrific case, I wan to ask: was guide extension being advanced through the Diagonal or LAD wire to help push the balloon through the stent strut? since we have to maintain the LAD wire in DKCrush

[@manosbrilakis]

It was advanced over both wires.

[@AA-nz2gb]

Thanks a lot. What was the jailed wire in the SB for? I thought we pull the SB wire before deploying the MB stent?

[@manosbrilakis]

You can definitely remove the wire from the SB before placing the main vessel stent since there is already a stent in the SB, but it can also be left for marking the course of the SB and facilitating main vessel stent delivery. The risk of wire entrapment is very low.

[@amrhanafymahmoud9829]

Excellent presentation. But sir I had seen another application for blocking Ballon in CVC. U was panelist can u explain it

[@manosbrilakis]

I am sorry I am not sure which case you are referring to.