The use of a second 0.014 inch coronary guidewire, along with the one being used to advance balloons or stents inside the coronary arteries during percutaneous coronary intervention (PCI), sometimes helps to address complex lesions — a method known as the “buddy” wire technique. This simple technique of using a second wire helps to advance the balloon or stent across the lesion while maintaining guiding catheter stability. In this paper, we report the technical aspects of one case in which a buddy wire helped to successfully complete the procedure.

Case Report. A 52-year-old normotensive, nondiabetic male who had an anterior wall myocardial infarction 10 months prior, presented in May 2005 with Class II chronic stable angina and a positive stress thallium test of the left anterior descending (LAD) territory. Coronary angiography revealed a 90% diffuse, calcified, type C lesion in the mid-LAD (Figure 1A). The patient underwent PCI of the mid-LAD lesion. The left coronary artery was hooked with an extra-support 6 Fr EBU 3.5 guiding catheter (Medtronic, Inc., Minneapolis, Minnesota). The mid-LAD lesion was crossed with 0.014 inch Cordis ATW coronary guidewire (Cordis Corp., Miami, Florida). A 2.5 x 20 mm Sprinter balloon (Medtronic) was unable to cross the calcified lesion (Figure 1B). A second 0.014 inch buddy wire was placed in the distal septal, following which the balloon was able to be negotiated across the lesion and successfully inflated (Figures 1C and 1D). A 3 x 33 mm Cypher® stent (Cordis) was positioned across the lesion without buddy wire assistance. It was deployed at 18 atmospheres with a favorable final result (Figure 1E).

Discussion. The buddy wire technique can be helpful in several situations during PCI.¹ Other than calcified lesions, it can aid in lesions with marked tortuosities, sharp bends, distal lesions and in lesions distal to stented segments.¹ It also helps to stabilize the guiding catheter in ostial, SVG and anomalously originating coronary arteries lesions, and reduces balloon slippage during balloon dilatation of in-stent restenotic lesions.¹ In the present case, where crossing the calcified lesion was not possible even with the use of an extra-support guiding catheter and deep hooking, a buddy wire helped to overcome the problem. It is possible that the second wire provides a smooth rail for a balloon or stent to advance along the luminal wall without snagging. In addition, it may decrease reverse torque transmission to the guiding catheter during PCI.

In conclusion, the buddy wire technique is a simple, inexpensive, quick, easily-available and deliverable method for tackling difficult anatomical lesions. It does not require any change of hardware during ongoing PCI, which is of great advantage as far as time and various periprocedural complications are concerned.^1,2