Over The Wire Balloons Underutilized: A Novel Techniques For
Standard modality for crossing a stenotic lesion is using a wire to cross the lesion in a native or graft vessel. The area of interest beyond the lesion will generally be visualized by angiogram. However, in certain cases with acute to sub-acute occlusion with limited TIMI flow one may have difficulty in locating the site of stenosis. This may occur for example when there is a distal stenosis of a bypass graft or superimposed thrombus throughout a vessel. These types of lesions may lead to difficult decision making in regards to plan of treatment, and tend to lead to increased risk of complications and unsuccessful outcomes. Dissemination of simple safer technique will help to reduce complications during these types of procedures. We describe a novel technique of visualizing and locating such areas of stenosis demonstrated via two cases; one involving native and one involving graft vessels.

Case Review
Our first case is of an eighty four year old gentleman with history of coronary artery disease with three vessel coronary artery bypass grafts done seven years prior. The grafts included right internal mammary artery to left anterior descending artery, left internal mammary artery to the first obtuse marginal branch, and saphenous venous graft to posterior descending artery. He was evaluated in the outpatient setting for worsening angina despite maximal medical therapy and subsequently underwent a nuclear medicine stress test. The stress test suggested an anterior septal area of reversible ischemia. Following these results the patient was scheduled for coronary angiography....