Figure 2.

Balloon anchoring used as an adjunct along with the reverse wire technique (A) Coronary angiogram (anterior-posterior view) with cranial angulation showing extremely angulated take-off (asterisk) of the left anterior descending artery (LAD), and a septal branch (red dotted line) at the bifurcation of the LAD and diagonal branch (DB) presenting near the take-off of the LAD; (B) Using the reverse wire technique, the guidewire inevitably went into the septal branch instead of the LAD (red line) due to the preferential angulation; (C) A 1.2-mm balloon (indicated by red arrows) was inflated across the bifurcation to support the wiring procedure and to ensure easy access to the angulated LAD; (D) With the support of the anchored balloon, the guidewire was successfully delivered to the targeted branch; (E) Coronary angiogram showing successful delivery of the guidewires into the LAD and DB, and stent deployment for the middle part of the LAD; (F) Final angiogram of the LAD after the intervention in right anterior view with cranial angulation.