A U-turn wiring technique for reverse-angled branches adjacent to ectasia: a case series

Background The reverse-wiring technique (RWT) using a hairpin-bend wire is useful for percutaneous coronary intervention of a bifurcation lesion with an extremely angulated side branch (SB); however, it is not necessarily effective in some anatomical situations. We report a novel SB wiring technique, the U-turn wiring technique (UWT), that is useful for wiring an extremely angled SB proximal to the ectasia. Case summary In the first case, the bare wire took a U-turn in the ectasia of the diagonal branch and crossed towards the angled left anterior descending artery, but a coronary dissection occurred in the diagonal branch due to the continuous wire-pushing force. Therefore, in the second case, we used a microcatheter with distal flexibility to prevent guidewire-induced vessel injury at the ectasia site and safely advanced the wire to the distal portion of the extremely angulated SB. Discussion The UWT takes advantage of the ectasia as a space to U-turn the guidewire. The UWT does not require a hairpin-bend guidewire or a dual-lumen catheter. The guidewire can be easily pushed forward through a reversed SB. After successful wire insertion, the guidewire can be easily advanced deep into the side branch. The UWT facilitates wire crossing to a reverse-angled branch utilizing the coronary ectasia anatomy through a simple manipulation.