Shepherd’s Crook Curve: A Novel Technique for Angulated Side Branch Access in Bifurcation Angioplasty

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 bifurc...

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Bibliographic Details
Main Authors: Kanhai Lalani, M. Sudhakar Rao, Suheil Dhanse, Tom Devasia, Hashir Kareem, Ganesh Paramasivam
Format: Article
Language:English
Published: Houston Methodist DeBakey Heart & Vascular Center 2024-08-01
Series:Methodist DeBakey Cardiovascular Journal
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Online Access:https://account.journal.houstonmethodist.org/index.php/up-j-mdbcj/article/view/1413
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Summary: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.
ISSN:1947-6108