PMC5779781_01
Bifurcation characteristics and the balloon block and support technique (BBST) procedure in case 1 and 2. A, B: Baseline angiography showed left anterior descending-first diagonal (LAD-D1) bifurcation lesions. C: Schematic diagram showing much more rapid LAD-D1 angulation than that apparent by visual estimation. D, E: Fluoroscopy showing that inflation of a balloon in the distal main branch facilitates side branch wiring. F, G: Baseline angiography showing left anterior descending-third diagonal (LAD-D3) bifurcation lesions and an extremely angulated D3. H: Schematic diagram depicting heavy plaque burden in the proximal main branch and rapid LAD-D3 angulation. I, J: Details of the BBST procedure.
medi-97-e9673-g002.jpg
PMC5779781_02_medi-97-e9673-g002.jpg
F1
As shown in Figure 1F-H, CAG showed a severe stenosis in the mid-LAD. After only one attempt, the guide wire was advanced and placed into the D3 successfully within 5 min (Figure 1I,J, Supplemental Video 2, which demonstrates the BBST procedure in case 2).
PMC5779781_02
Bifurcation characteristics and the balloon block and support technique (BBST) procedure in case 1 and 2. A, B: Baseline angiography showed left anterior descending-first diagonal (LAD-D1) bifurcation lesions. C: Schematic diagram showing much more rapid LAD-D1 angulation than that apparent by visual estimation. D, E: Fluoroscopy showing that inflation of a balloon in the distal main branch facilitates side branch wiring. F, G: Baseline angiography showing left anterior descending-third diagonal (LAD-D3) bifurcation lesions and an extremely angulated D3. H: Schematic diagram depicting heavy plaque burden in the proximal main branch and rapid LAD-D3 angulation. I, J: Details of the BBST procedure.
medi-97-e9673-g002.jpg
PMC5779781_02_medi-97-e9673-g002.jpg
F1
As shown in Figure 1F-H, CAG showed a severe stenosis in the mid-LAD. After only one attempt, the guide wire was advanced and placed into the D3 successfully within 5 min (Figure 1I,J, Supplemental Video 2, which demonstrates the BBST procedure in case 2).
Mechanisms and theoretical indications of the balloon block and support technique (BBST). A, B: In cases with severe angulation of greater than 70  between the distal main branch (DMB) and side branch (SB) (A), and cases with heavy plaque burden or significant stenosis in the proximal main branch (PMB) near the SB ostium (SBO) (B), balloon inflation provides upward support for the guide wire by blocking the DMB pathway and facilitating guide wire advancement into the SB. C: DMB wiring in Medina 1,1,1 with the balloon placed in the SB.
medi-97-e9673-g003.jpg
PMC5779781_02_medi-97-e9673-g003.jpg
F2
After only one attempt, the guide wire was advanced and placed into the D3 successfully within 5 min (Figure 1I,J, Supplemental Video 2, which demonstrates the BBST procedure in case 2).