Optimal angiographic success after coronary artery stenting, defined as <20% residual stenosis by quantitative coronary analysis (QCA), is frequently obtained with high-pressure inflations.¹ This angiographic endpoint has been associated with suboptimal stent expansion and apposition by intravascular ultrasound (IVUS) criteria in 26–46% of patients.^2–4 Previous investigators have defined optimal stent expansion using IVUS criteria and have associated it with reduced rates of restenosis and target lesion revascularization.^3,5–7 However, angi

The treatment of bifurcation stenoses (BS) by percutaneous coronary intervention (PCI) is challenging due to their lower procedural success and higher restenosis rates compared with nonbifurcation coronary stenoses.^1,2 Although dedicated techniques and new stent designs have been developed for treating BS with bare-metal stents (BMS), the restenosis rates remained high, with up to 25.7% in a large randomized trial performed in the drug-eluting stent (DES) era.³ Indeed, in recent decades, several treatment strategies have been conceived for BS, including contemporary im

Case Presentation. A 43-year-old male with a history of myocardial infarction and primary stenting (left circumflex artery in July 1997 and right coronary artery in September 2005) was admitted to undergo angioplasty for his totally reoccluded left circumflex artery (Figure 1A). After a hydrophilic-coated soft wire with a microcatheter failed to cross the lesion, a tapered-tip stiff wire, designed for chronic total occlusions, was able to cross the lesion.¹ Neither the microcatheter nor a 2.0 x 15 mm balloon was able to cross the in-stent reoccluded segment,