New Technique of Balloon Crossing in Buddy Wire Method in Coronary Angioplasty: A Case Report
Abstract
Anand R Shenoy, Sneha Karekar and D Vijay Kumar
Background: Failure of a post-dilatation balloon to cross a previously deployed coronary stent can pose a technical challenge during percutaneous coronary intervention (PCI), even when the primary guidewire is successfully positioned and guide-catheter support is adequate. Unfavourable guidewire bias or vessel geometry may impede balloon advancement. We describe a modified buddy-wire exchange technique to overcome this limitation.
Objective: To describe a novel guidewire repositioning manoeuvre that facilitates balloon delivery for post-dilatation of a previously deployed coronary stent when conventional balloon advancement over the primary guidewire fails.
Technique: When a post-dilatation balloon fails to cross a previously deployed coronary stent over the primary guidewire despite adequate guide support, especially after using guideline or guide plus catheter, a second guidewire is introduced as a buddy wire, and balloon advancement is attempted over the secondary guidewire. If the balloon still fails to cross, the primary guidewire is withdrawn while maintaining the secondary guidewire and the balloon catheter in position near the point of resistance, provided stable positioning can be safely maintained. The primary guidewire is then reintroduced, preferably using a distal loop configuration, and advanced back to the coronary ostium before being redirected into the target vessel. Balloon advancement is subsequently reattempted over the secondary guidewire. In our experience this manoeuvre almost always works, this manoeuvre is intended to alter the primary guidewire course and reduce unfavourable wire bias, thereby improving balloon alignment and facilitating passage through the previously deployed stent.
Conclusion: This modified buddy-wire exchange technique may offer a simple bailout strategy for failure of post- dilatation balloon delivery through a previously deployed coronary stent. By modifying guidewire geometry while maintaining secondary-wire access, the technique may facilitate balloon passage without immediate escalation to more complex device-delivery strategies. Further clinical evaluation is required to establish its procedural success, safety, reproducibility, and applicability across different coronary anatomies and stent configurations.