Case report of a novel maneuver to facilitate wire access to the side branch in bifurcation intervention-balloon block and support technique

Figure 1. Bifurcation characteristics and the balloon block and support technique (BBST) procedure in case 1 and 2. A, B: Baseline angiography showed left anterior descending-first diagonal (LAD-D1) bifurcation lesions. C: Schematic diagram showing much more rapid LAD-D1 angulation than that apparent by visual estimation. D, E: Fluoroscopy showing that inflation of a balloon in the distal main branch facilitates side branch wiring. F, G: Baseline angiography showing left anterior descending-third diagonal (LAD-D3) bifurcation lesions and an extremely angulated D3. H: Schematic diagram depicting heavy plaque burden in the proximal main branch and rapid LAD-D3 angulation. I, J: Details of the BBST procedure.

Figure 2. Mechanisms and theoretical indications of the balloon block and support technique (BBST). A, B: In cases with severe angulation of greater than 70° between the distal main branch (DMB) and side branch (SB) (A), and cases with heavy plaque burden or significant stenosis in the proximal main branch (PMB) near the SB ostium (SBO) (B), balloon inflation provides upward support for the guide wire by blocking the DMB pathway and facilitating guide wire advancement into the SB. C: DMB wiring in Medina 1,1,1 with the balloon placed in the SB.