Paying for inadequate predilatation during angioplasty

Adequate predilatation and balloon sizing of the lesion are must during coronary angioplasty. A well-prepared lesion not only responds well to stent expansion but also helps visualization of the lesion during stent implantation because of good antegrade flow despite the stent across the lesion. In this illustration, we just missed the distal part of lesion during angioplasty of critical stenotic lesion in the left anterior descending artery in a 54-year-old woman with crescendo angina despite predilatation. Because of inadequate predilatation, residual significance stenosis limited the forward flow of contrast when the stent was across the lesion for positioning before expansion. The narrow error in the judgment costed an additional stent to complete the procedure.