A novel buddy balloon technique to recross a T-stented bifurcation.

The T technique is not uncommonly used to stent bifurcation lesions. It requires recrossing into the side branch with a guidewire and balloon to perform final Kissing Balloon dilations, but recrossing can be difficult. We describe a case of bifurcation stenting where balloon recrossing following guidewire placement into the side branch proved very challenging, and was finally achieved via a combination of forward pressure on a low-profile balloon with its tip wedged at the stent struts along with simultaneous low-pressure inflation of a larger parallel balloon. This altered the stent architecture and also allowed for a more favorable vector of force transmission to allow recrossing and hence successful completion of the procedure.

"Backdoor" alternative approach to stenting of a post-anastomotic coronary artery lesion via a chronically obstructed right coronary artery after failure to stent through a tortuous free internal mammary graft.

We describe the case of a patient who previously had coronary artery bypass grafting including a free right internal mammary artery graft anastomosed to a chronic totally occluded right coronary artery (RCA) proximally and distally and who presented with a high-risk acute coronary syndrome. Coronary angiography revealed the graft to be patent with a distal post-anastomotic culprit lesion within the posterolateral branch of the native RCA. Because of technical challenges, PCI could not be performed through the graft and the lesion was stented via the chronically occluded RCA instead, in a "backdoor" approach with a good final result.