# Shepherd’s Crook Curve: A Novel Technique for Angulated Side Branch Access in Bifurcation Angioplasty

## TL;DR

This paper introduces a new technique called the 'shepherd’s crook wire curve' to improve access to angled side branches during coronary bifurcation interventions.

## Contribution

The novel 'shepherd’s crook wire curve' technique is introduced for challenging bifurcation angioplasty cases.

## Key findings

- The shepherd’s crook wire curve successfully enabled access to a major diagonal branch with an unfavorable angle (>120°).
- The technique is a modification of the reverse wire technique and resembles a shepherd’s crook in shape.

## Abstract

Coronary intervention involving the region of bifurcation remains a challenging issue for the cardiologist as well as a complication. A number of factors including the angulation of side branch with the main branch determines the success. Though provisional strategy remains the best option in bifurcation intervention, at times a two-stent strategy cannot be avoided. We report a case in which percutaneous coronary intervention was performed on the left anterior descending artery (LAD) at its bifurcation with a major diagonal branch (> 2.5 mm). The ostium of the diagonal was diseased, and the branch took off from the LAD at an unfavorable angle (> 120°). We describe the use of the “shepherd’s crook wire curve” approach, a modification of the reverse wire technique, which allowed us to successfully wire, dilate, and protect the diagonal and so named to reflect its resemblance to the shape of a shepherd’s crook.