Case 160: Manual of PCI - Blocking balloon

A patient presented with unstable angina. The culprit lesion was an LAD/diagonal bifurcation lesion. PCI with DK crush was performed. Rewiring the diagonal after deploying the LAD stent was challenging: using a polymer jacketed wire and a dual lumen microcatheter failed. We placed a balloon in the LAD immediately distal to the origin of the diagonal (deflection balloon technique). The deflection allowed advancement of a Sion black wire into the diagonal. Balloon and microcatheter advancement initially failed but subsequently succeeded using a deploy seated guide extension with a nice final result.