We performed the ‘rescue’ balloon jailing and a switch crush technique to open the jailed SB (Figure 2). First, we dilated the compromised SB ostium over the jailed SB wire with 1.5-mm and 2.5-mm balloons sequentially (Figure 2A-C). Externally, we introduced a second stent long enough to cover from the proximal part to the LAD stent and beyond the dissection flap into the jailed SB (two Orsiro^® stents 2.5×35 and 2.75×40 mm; Biotronik), facilitated by the guide extension catheter minimizing friction with the pre-implanted LAD stent (Figure 1C and Figure 2D-F, Supplementary Videos 5 and 6). Following SB stent implantation (Figure 2G), we rewired the LAD lesion through the LAD stent struts and performed a final kissing balloon inflation (two NC Emerge™ balloons, 3.0×15 and 2.75×15 mm; Boston Scientific Corporation [BSC], Natick, MA, USA) (Figure 2H, Supplementary Videos 7 and 8).

Even after applying the ‘rescue’ balloon jailing technique,1)2) we could not rewire the SB due to severe SB dissection. Under such emergency, the novel ‘switch crush technique’ represents the last option to save the significant SB in danger.

We obtained informed consent from the patient and her son to report the case.