BTS (balloon-trap straightening) technique for the completion of reversed wire technique

Inserting a guidewire into an extremely angulated side branch (SB) is difficult in percutaneous coronary intervention (PCI). Reversed wire technique (RWT) method was developed to specifically overcome this challenging situation, and it has become common among operators performing PCI. During the procedure of RWT, we sometimes have difficulty in straightening the reversed bend due to lack of intentional control of the RW and fail in an attempt of wire insertion into target branch. BTS (balloon-trap straightening) technique is a novel method we developed to facilitate straightening the reverse bend. It consists of the following steps: 1) Extracting a dual lumen catheter (DLC). 2) Advancing a balloon via a guidewire of the main vessel and dilating it at the bifurcation to stabilize the RW position. 3) Pulling back the RW gently to straighten the reversed bend while trapping the RW at the bifurcation. 4) Inserting a micro-catheter via the RW to steer the guidewire distally. This technique could be a simple yet effective method to overcome the difficulty of straightening the bend of the reverse wire. It also helps us to save time and effort in accomplishing SB access, even during the treatment of complex bifurcated lesions.