Successful percutaneous coronary intervention for complex bifurcated lesions with combination of "Reverse wire technique" and "Reverse bent wiring with the crusade catheter" novel wire manipulation technique

Abstract

We encountered a case of percutaneous coronary intervention for complex bifurcated lesions in the mid portion of the left anterior descending (LAD) artery. The diagonal artery branched from the LAD artery with a markedly angulated pattern and there was severe stenosis from just proximal to this diagonal artery. The "reverse wire technique facilitated with the Crusade catheter" enabled us to cross a guidewire through to the markedly angulated diagonal side branch (SB). Next, we adopted a mini-crushing stent strategy for this true bifurcated lesion. Thereafter, we adopted "reverse bent wiring with the Crusade catheter" for wire re-crossing to the incarcerated side branch, and successfully completed all procedures. This technique for successful wire re-crossing is simple but can be very effective in specific situations in practical percutaneous coronary intervention (PCI). Many PCI operators may empirically adopt this kind of wire manipulation technique. However, this case is the first report in the world describing the application of a "reverse bent wiring with the Crusade catheter" for wire re-crossing through a double-folded stent strut to a SB at the optimal point of the bifurcation. In this case, we made the most of the Crusade catheter. This catheter is a very useful device for multifactorial use in practical PCI. It can help us to perform complex PCI procedures successfully.

Keywords: reverse bent wiring; reverse wire technique; side branch.