PMC5546646_01
(a) Right coronary angiogram of the left anterior oblique cranial view. (b, c) Stent implantation using the jailed semi-inflated balloon technique. (d) Right coronary angiogram of the left anterior oblique cranial view after stent implantation. (e) Proximal optimization technique using a non-compliant balloon. (f) Final coronary angiogram.
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Coronary angiography revealed a true bifurcation lesion in the distal segment of the RCA between the posterior atrioventricular (PAV) artery and posterior descending artery (PDA) with an obtuse angle (Medina classification 1.1.1; Figure 1(a)). The side branch balloon (Tazuna 2.0 x 20 mm; Terumo) in the PDA was initially inflated at low pressure (3 atm; Figure 1(b)). Subsequently, the main branch stent balloon (Ultimaster 2.75 x 33 mm; Terumo) in the PAV was inflated at nominal pressure, which jailed the side branch semi-inflated balloon (Figure 1(c)). Blood flow was preserved in both the PAV and the PDA after main vessel stenting (Figure 1(d)). For optimization of stent apposition of the main branch, the proximal optimization technique was performed with a non-compliant balloon (Lifespear HP 3.25 x 12 mm; Japan Lifeline, Tokyo, Japan) (Figure 1(e)). A final coronary angiogram showed excellent results without any complications, including side branch narrowing or occlusion (Figure 1(f)).
(a) Optical frequency domain imaging at the site of the side branch orifice after stent implantation. (b) Three-dimensional optical frequency domain imaging after stent implantation.
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Because three-dimensional OFDI (Terumo) clearly showed that the orifice of the PDA was patent (Figure 2(a) and (b)), we decided not to perform final kissing balloon inflation, and the protection guidewire was removed from the PDA.