[How to solve difficult side branch access: case report and literature review]

Area of Science:

• Interventional Cardiology
• Cardiovascular Medicine

Background:

• Complex coronary artery bifurcation lesions pose significant challenges in percutaneous coronary intervention (PCI).
• Accurate lesion assessment is crucial for procedural planning and success.

Observation:

• A 53-year-old patient with hypertension and dyslipidemia presented with effort-induced angina due to a complex LAD-Diagonal bifurcation lesion (MEDINA 1-1-1).
• Initial PCI using the TAP technique resulted in loss of side branch flow and ST-elevation myocardial infarction.
• Successful restoration of flow was achieved using a rescue jailed balloon and specialized guidewire for side branch re-access.

Findings:

• The case illustrates common pitfalls in complex bifurcation PCI, including side branch compromise.
• The rescue jailed balloon technique and specific guidewires (e.g., Gaia First®) can effectively manage side branch access issues.
• Successful recanalization and flow restoration were achieved, resolving the acute complication.

Implications:

• This case underscores the importance of advanced techniques and troubleshooting skills in complex bifurcation PCI.
• It provides valuable insights for interventional cardiologists facing similar challenging cases.
• Adopting these strategies can improve outcomes and reduce complications in bifurcation interventions.