Going around the bend: deep inspiration facilitates difficult stent delivery in the native coronary arteries

Percutaneous coronary intervention in tortuous or calcified vessels poses a substantial challenge for interventional cardiologists. Many techniques have been described to overcome the challenge, including the use of stiffer wires, buddy wires, the anchor balloon technique, and deep seating of the guide catheter. Herein, we describe a way to facilitate stent delivery in many tortuous, calcified, and acutely angled vessels: having the patient take a deep breath during the delivery. Deep inspiration displaces the diaphragm and the heart into a more vertical position and causes the coronary tree to straighten slightly, which facilitates balloon and stent delivery. We have found that this method minimizes patients' radiation exposure and saves substantial time and expense in many balloon and stent deliveries that would otherwise be challenging.