Acute stent malapposition poses a significant risk for adverse cardiac events following percutaneous coronary intervention. Detection of acute stent malapposition traditionally relies on intracoronary imaging techniques, such as intravascular ultrasound and optical coherence tomography, which may be limited in developing countries due to accessibility issues. A new angiographic sign called the POT-PUFF sign has been introduced as a potential alternative for detecting malapposition during coronary bifurcation procedures. Here, we present two clinical cases from a developing country where the POT-PUFF sign was employed to assess the result of proximal optimization therapy after stent implantation. The POT-PUFF sign exhibits potential as an affordable and feasible approach for assessing stent malapposition in settings with limited resources.

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