A Novel Push-Fold Method for Removing Side Branch-Jailed Stent Struts Under 3D Optical Coherence Tomography Guidance.

A 70-year-old woman with stenosis at the bifurcation of the left anterior descending artery (LAD) and diagonal branch (Dx) underwent implantation of a Xience Alpine stent (2.5 23 mm; Abbott Vascular, Abbott Park, Illinois) in the LAD under 3-dimensional (3D) optical coherence tomography (OCT) (St. Jude Medical, St. Paul, Minnesota) guidance. 3D-OCT image reconstruction using Intage Realia software (Cybernet, Tokyo, Japan) (1) showed the guidewire crossing position and stent link location. The guidewire crossed the distal stent cell between the strut and carina, separated by the link at the middle of the carina (Figure 1A). Previous experience with stent deformation in the distal LAD after kissing balloon inflation (KBI) (Figure 2A) led us to re-cross the guidewire, aiming for the proximal cell. 3D-OCT showed the guidewire passing through the target cell (Figure 1B). A semicompliant balloon (2.0 15 mm) was dilated with 4 atm in the proximal LAD (before crossing the stent cell) and pushed toward the Dx to invert the jailed strut at the carina to