Case 68 - PCI Manual - Branch ostial lesion

A patient presented with NSTEMI and due to a hazy ostial 2nd obtuse marginal lesion (branch ostial lesion, Medina 0.0.1). The OM2 and distal circumflex were wired with workhorse guidewires leading to acute closure of OM2. Antegrade flow was restored in the OM2 after balloon angioplasty. The guidewire had entered into a small branch and could be redirected distally after knuckling. The initial plan was to perform mini-crush, however because the OM2 was actually larger than the distal circumflex provisional stenting was performed considering OM2 as the main vessel (Medina 0.1.0 bifurcation) with an excellent final result after using the proximal optimization technique.

[@odraccir80]

Thanks for sharing this case. What about the use of drug coated balloon as first choice in true Medina 0-0-1?

[@АртемГаврилко-к3ч]

Thank you! In which cases do you perform KBI before POT, if initially provisional strategy was selected?

[@drgskgraju4563]

DEB would be my first choice

[@drsherb1552]

Thank you very much. so if the diseased vessel is the more important vessel one do provisional stenting for extra protection of the important vessel. but if the diseased vessel is the less important vessel go for T-stenting or mini crush. Thank you very very much.

[@tom11298]

Great and very educational. I had the same case lately, done same approach
The GW being jailed, was stuck, could not be removed, only advancing a 1.5 ballon over the jailed wire could help and free that wire.
I think the longer the stent and the longer the portion of the jailed wire behind the stent, the more the risk of entrapment.
would you consider doing provisional hier (0-1-0), with only one wire in the main vessel (as the the ostium of the SB (the RCX/OM3) is free of disease and 70-90 degree to the MV)?

[@manosbrilakis]

I would still jail a wire in the SB, even if the likelihood of occlusion is low, because our ability to predict SB compromise is limited. To minimize the risk of entrapment, a microcatheter or balloon can be advanced over the jailed guidewire if there is any resistance during attempts to withdraw it.

[@schiefix]

Virtually nobody uses Minicrush in the UK. TAP would be the way to go in

[@drmahbuborrahman1061]

Wonderful teaching

[@shangz0216]

Thanks for your sharing.

[@drmahbuborrahman1061]

Nice demonstration