Brief report Inverted Crush Technique for Uncrossable Side Branch Occlusion During Provisional Side Branch Stenting: a New Role for the Jailed Wire Manuel Pan, a, * Miguel Romero, a Soledad Ojeda, a Jose Segura, a Francisco Mazuelos, a Javier Sua ´ rez de Lezo, a Alfonso Medina, b and Jose Sua ´ rez de Lezo a a Servicio de Cardiologı´a, Hospital Universitario Reina Sofia, Universidad de Co ´rdoba, Co ´rdoba, Spain b Servicio de Cardiologı´a, Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Las Palmas, Spain INTRODUCTION Provisional side-branch (SB) stenting is currently the most widely accepted percutaneous technique for the treatment of bifurcation lesions. 1 This approach basically consists of stenting the main vessel and balloon dilation of the SB. When the results are suboptimal at the SB, a second stent can be implanted in this coronary segment. Provisional stenting has been called a simple approach; 2 however, the technique may not be so simple and, after main vessel stent implantation, abrupt closure of the SB may occur due to carina/plaque shifting. Resolving SB stenosis under these conditions may pose major technical difficulties, especially if the vessel closure causes severe hemodynamic impairment during the procedure. METHODS We describe a new technique to quickly resolve uncrossable SB occlusion after main vessel (MV) stent implantation during Rev Esp Cardiol. 2011;xx(x):xxx–xxx Article history: Received 7 June 2010 Accepted 18 October 2010 Keywords: Bifurcations Provisional stenting Side-branch occlusion ABSTRACT Provisional side-branch stenting is currently the most widely accepted percutaneous technique for the treatment of bifurcation lesions. However, abrupt closure of the side branch may occur after main vessel stent implantation. Resolving side-branch stenosis under these conditions may pose major technical difficulties. We describe a new technique to resolve uncrossable side-branch occlusion following main- vessel stent implantation during provisional side-branch stenting. The technique consists of using the jailed wire to dilate the occluded side branch. We first use a low profile, 1.25-mm diameter balloon catheter. A regular balloon is then inflated through the same wire to open the side branch, crushing the proximal part of the main vessel stent. At this point, a second stent is implanted at the side-branch, finishing the procedure as an inverted crush stenting. The described strategy may be useful in cases of uncrossable side-branch occlusion causing severe hemodynamic impairment that cannot be swiftly managed with conventional methods. ß 2010 Sociedad Espan ˜ ola de Cardiologı ´a. Published by Elsevier Espan ˜ a, S.L. All rights reserved. Te ´ cnica de aplastamiento invertido para la oclusio ´ n infranqueable de la rama lateral en la angioplastia coronaria de bifurcaciones: un nuevo papel de la guı ´a enjaulada Palabras clave: Bifurcaciones Implantacio ´n de stent condicional Oclusio ´ n de rama lateral RESUMEN La implantacio ´ n condicional de un stent en una rama lateral es actualmente la te ´ cnica percuta ´ nea ma ´s ampliamente aceptada para el tratamiento de las lesiones de bifurcaciones. Sin embargo, puede producirse una oclusio ´ n brusca de la rama lateral tras la implantacio ´ n de un stent en el vaso principal. La resolucio ´ n de la estenosis de la rama lateral en estas circunstancias puede plantear dificultades te ´ cnicas importantes. Describimos una nueva te ´ cnica para resolver la oclusio ´ n infranqueable de una rama lateral tras la implantacio ´n de un stent en el vaso principal en la angioplastia coronaria de bifurcaciones. La te ´ cnica consiste en utilizar la guı ´a enjaulada para dilatar la rama lateral ocluida. Utilizamos primero un cate ´ ter-balo ´ n de un dia ´metro de 1,25 mm y de perfil bajo. A continuacio ´ n se hincha un balo ´ n regular a trave ´s de la misma guı ´a para abrir la rama lateral, aplastando la parte proximal del stent del vaso principal. En este punto, se implanta un segundo stent en la rama lateral, y se finaliza el procedimiento como una implantacio ´ n de stent con aplastamiento invertido. La estrategia descrita puede ser u ´ til en los casos de oclusio ´ n infranqueable de la rama lateral que causa un deterioro hemodina ´mico grave y no puede resolverse fa ´ cilmente con los me ´ todos convencionales. ß 2010 Sociedad Espan ˜ ola de Cardiologı ´a. Publicado por Elsevier Espan ˜ a, S.L. Todos los derechos reservados. * Corresponding author: Servicio de Cardiologı ´a, Hospital Reina Sofı ´a, Avda. Mene ´ ndez Pidal 1, 14004 Co ´ rdoba, Spain. E-mail address: manuelpan@telefonica.net (M. Pan). G Model REC-111; No. of Pages 5 Please cite this article in press as: Pan M, et al. Te ´ cnica de aplastamiento invertido para la oclusio ´ n infranqueable de la rama lateral en la angioplastia coronaria de bifurcaciones: un nuevo papel de la guı ´a enjaulada. Rev Esp Cardiol. 2011. doi:10.1016/j.recesp.2010.10.033 1885-5857/$ – see front matter ß 2010 Sociedad Espan ˜ ola de Cardiologı ´a. Published by Elsevier Espan ˜ a, S.L. All rights reserved. doi:10.1016/j.rec.2010.10.034