Fundamentals of percutaneous coronary bifurcation interventions

Figure 4 Provisional stenting technique, step-by-step. A: Both branches are wired; B: A stent sized to the distal MV diameter is implanted in the MV; C: Proximal optimization technique (POT) application with a balloon sized to the proximal MV diameter with its distal shoulder aligned to the carina; D: Stent view after POT. If the result is satisfactory, stop here. If not, proceed to step E; E: Guidewire exchange; First, the SB is wired through the most distal cell. Second, the retracted and released SB wire is advanced into the distal MV as a “U” shape; F1: Kissing balloon inflation sized to branch diameters, or F2: SB ostium ballooning as a part of the POT-side-POT technique; G: Final POT; and H: Final result. MV: Main vessel; POT: Proximal optimization technique; SB: Side branch.