The crooked buddy technique: use of a Wiggle wire alongside an extra support wire to improve device deliverability

The buddy wire is a useful technique for difficult-to-cross lesions that are typically identified by poor guide support, vessel tortuosity, calcification and/or prior stent placement. We present 5 cases of percutaneous coronary interventional success involving difficult-to-cross lesions using the "crooked buddy" technique, a unique combination of the Wiggle guidewire as the rail and an extra support guidewire as the buddy wire. From our experience, we recommend that when difficult-to-cross lesions are identified, moving quickly to the crooked buddy technique may avoid unnecessary equipment, contrast and procedure time.