A patient with crescendo angina was found to have a Medina 1.0.1 LAD/diagonal bifurcation lesion. A decision was made to treat it with provisional stenting considering the diagonal as the main vessel and the LAD as the side branch. OCT showed lesion length of 33 mm with 2.55 mm proximal reference and 4.20 mm distal reference. After provisional stenting with a 3.0x33 mm DES and POT (proximal optimization technique) with a 3.5 mm balloon there remained proximal malapposition. Repeat POT was done with a 4.0 mm balloon with a nice final result albeit slightly exceeding the labeled stent postdilation limit. Post-PCI LAD dPR was 0.91, hence no further PCI was done in the LAD.
