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.