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A patient was referred for treatment of a partially deployed Palmaz-Schatz coronary stent placed in the left anterior descending (LAD) coronary artery. After crossing the stent with a guidewire, the stent was optimally dilated with a high-pressure balloon. Several novel methods used to achieve success are discussed, along with suggestions on how to avoid common problems.

We report the treatment of a bifurcation stenosis using kissing stents. Three Palmaz-Schatz stents were deployed in each limb of a left anterior descending artery/diagonal bifurcation, providing excellent angiographic and 5 month clinical follow-up results.

A series of high-speed rotational atherectomy cases is discussed in which pseudostenosis was noted following initial guidewire placement. The results and technical considerations when using the Rotablator in the setting of guidewire-induced pseudostenosis are discussed.

The initial clinical experience with a novel device designed to facilitate guide catheter exchange during coronary angioplasty while maintaining a secure guidewire position (Marathon Relay, Baxter Interventional Cardiology, Irvine, CA) is described. Over a 7-month period, 23 guide catheter exchanges were attempted during 20 procedures. The angioplasty procedure involved the use of newer devices in 65% of attempts with coronary stent deployment in 50% of attempts. In the majority (57%) of cases, exchanges were performed to allow improved guide catheter support. The exchange procedure was successful in 91% of attempts. Ultimate procedural success was achieved in 95% of patients with no complications. In this early experience, this device was found to be safe and effectively facilitated guide catheter exchange.

Occasionally, the usable length of a balloon angioplasty or other therapeutic catheter is insufficient to reach the target stenosis. We describe a technique of shortening the guide catheter from the proximal end in vivo without removing the coronary guidewire. This permits greater projection of the therapeutic catheter to reach distal stenoses.

Angioplasty of large (greater than 4.0-mm) saphenous vein grafts using the largest available (4.0-mm) balloon catheters may result in inadequate graft dilatation. To avoid leaving a significant residual stenosis, two balloon catheters can be inflated side by side across the stenosis. Herein, we report two cases where this "hugging balloon" technique was used to achieve wide graft patency.