When one won't do it, use two-double "buddy" wiring to facilitate stent advancement across a highly calcified artery.

Percutaneous coronary intervention (PCI) of heavily calcified vessels poses several problems including difficulty in delivering stents to the target lesion. Effective strategies include rotational atherectomy and the use of a "buddy" wire, the latter acting as a track that directs the stent away from the vessel wall. There are no reports in the literature of using a second "buddy" wire when one fails. We report on a case of a second "buddy" wire saving the day during PCI of a highly calcified right coronary artery wherein the stent failed to reach the lesion until the second wire was deployed.