case_images: PMC11312719_01
case_images: Diagnostic angiogram in right anterior oblique 40 cranial 40 view using a 6F catheter (radial access) showing a true bifurcation stenosis of the left anterior descending (LAD) diagonal junction. The ostium of the large diagonal is diseased and arises from the LAD at an angle of approximately 130  with the main branch (inset).
case_images: mdcvj-20-1-1413-g1.jpg
case_images: PMC11312719_01_mdcvj-20-1-1413-g1.jpg
case_images: F1
case_images: A coronary angiogram performed via transradial access revealed 80% stenosis of the proximal left anterior descending artery (LAD) across the ostium of the first (major) diagonal branch as well as an additional 50% stenosis across the major septal branch (Figure 1).
case_images: Angiogram images (2a-c) of percutaneous intervention (2a) through the femoral route showing advancement of the wire beyond the tip of the micro-catheter such that the wire assumed its pre-formed shape; (2b) the micro-catheter was withdrawn back into the guiding catheter, and with careful rotational manipulation the wire was pulled back until its tip engaged the ostium of the diagonal branch; (2c) once the wire tip entered the diagonal, the wire was advanced while torquing. Line diagram (2d-f) depicting the same information.
case_images: mdcvj-20-1-1413-g2.jpg
case_images: PMC11312719_01_mdcvj-20-1-1413-g2.jpg
case_images: F2
case_images: To successfully wire the diagonal branch with an angulated take-off, we used a shepherd's crook wire curve (Figure 2).
case_images: Diagnostic angiogram and line diagram image showing shepherd's crook curve: beginning approximately 6 mm from the tip, a bend of 180  opposite the direction of the primary curve was introduced into the wire.
case_images: mdcvj-20-1-1413-g3.jpg
case_images: PMC11312719_01_mdcvj-20-1-1413-g3.jpg
case_images: F3
case_images: A bend that was 180  opposite to the direction of the primary curve was introduced into the wire, 1 mm from the tip, so that the wire was shaped like a shepherd's crook (Figure 3).
case_images: An angiogram in the right anterior oblique 40 cranial 40 view shows the final TIMI III flow in the left anterior descending artery after stenting and post dilatation with a non-compliant balloon.
case_images: mdcvj-20-1-1413-g4.jpg
case_images: PMC11312719_01_mdcvj-20-1-1413-g4.jpg
case_images: F4
case_images: The LAD was stented successfully with a 2.5-mm stent and post-dilated with a 3-mm noncompliant balloon (Figure 4).