Related Experiment Video
Updated: Jun 27, 2026
Microsurgical Venous Pouch Arterial-Bifurcation Aneurysms in the Rabbit Model: Technical Aspects
Published on: May 11, 2011
Shepherd's Crook Curve: A Novel Technique for Angulated Side Branch Access in Bifurcation Angioplasty
Kanhai Lalani1,2, M Sudhakar Rao3, Suheil Dhanse4
1Kasturba Medical College, Manipal.
Insights
Coronary bifurcation interventions are complex. A novel "shepherd's crook wire curve" technique successfully addressed a challenging left anterior descending artery bifurcation with an unfavorable angle, ensuring optimal treatment.
Area of Science:
- Interventional Cardiology
- Vascular Interventions
- Medical Device Technology
Background:
- Coronary artery bifurcation lesions present significant challenges in percutaneous coronary intervention (PCI).
- The provisional strategy is preferred, but complex anatomy sometimes necessitates a two-stent approach.
- Unfavorable bifurcation angles and diseased side branches complicate procedural success.
Observation:
- A case involving PCI of the left anterior descending artery (LAD) bifurcation with a major diagonal branch is presented.
- The diagonal branch originated at an unfavorable angle (>120°) with ostial disease.
- Standard techniques proved difficult for accessing and treating the diagonal branch.
Findings:
- A modified reverse wire technique, termed the "shepherd's crook wire curve," was successfully employed.
- This technique facilitated guidewire access, balloon dilation, and stenting of the diagonal branch.
- The unique curve of the guidewire, resembling a shepherd's crook, enabled navigation in the complex anatomy.
Implications:
- The "shepherd's crook wire curve" offers a valuable solution for challenging coronary bifurcation interventions.
- This technique enhances the ability to treat complex side branch lesions, potentially improving outcomes.
- It represents an innovative approach to managing unfavorable anatomy during PCI of bifurcations.
Abstract:
Coronary intervention involving the region of bifurcation remains a challenging issue for the cardiologist as well as a complication. A number of factors including the angulation of side branch with the main branch determines the success. Though provisional strategy remains the best option in bifurcation intervention, at times a two-stent strategy cannot be avoided. We report a case in which percutaneous coronary intervention was performed on the left anterior descending artery (LAD) at its bifurcation with a major diagonal branch (> 2.5 mm). The ostium of the diagonal was diseased, and the branch took off from the LAD at an unfavorable angle (> 120°). We describe the use of the "shepherd's crook wire curve" approach, a modification of the reverse wire technique, which allowed us to successfully wire, dilate, and protect the diagonal and so named to reflect its resemblance to the shape of a shepherd's crook.
