Background: Stent delivery into highly tortuous and/or calcified coronary lesions represents a common and often highly challenging problem for many interventional cardiologists. 7 or 8 french guides, guide extensions, anchor balloons and buddy wires are commonly used to overcome these issues. However, like always, these come with a cost. Especially large guides and extensions as well as anchor balloons are traumatic an may lead to dissection and no reflow. In this small case series of 5 patients with highly tortuous and or calcified lesions with multiple coronary stenoses, large stents could not be delivered.

Methods: We used a Sion blue® guidewire as a buddy wire. Then, we delivered a small, highly flexible stent into the most distal lesion jailing the Sion blue guidewire. The concept is similar to an anchor balloon and creates tremendous support. Instead of retrieving the buddy wire after initial stent placement, we left the buddy wire in place and were then easily able to deliver even large and long and thus more bulky stents to the more proximal lesions. Retrieving of the buddy wire was easily possible in all cases even after placement of multiple large stents.

Conclusion: Jailing a buddy wire might offer a strategy for delivering equipment into highly tortuous and calcified lesions. Obvious benefits include a decreased risk of dissection when compared to a distal anchor balloons. Furthermore, coronary flow is not compromised during the procedure. On the other hand, one has to deliver a small, flexible stent to the distal lesion first. There is also a risk of guidewire entrapment, however with contemporary coronary wires with hydrophobic coating, increased flexibility and durability, this risk may be significantly diminished. Indeed, we did have no difficulties retrieving the buddy-wire in any case.