We balloon, we stent; this is what we do. If there is a narrowing, we open it, and with this act we conjure a sense of relief. The stenosis is gone. Safety has returned, and everything is back to normal. We do this even with years of data telling us that a stenosis may not actually be as tight as it appears [1,2] or that it may not be causing any limitation of flow [3][4][5][6], and we do this knowing that if either is the case, we have likely done nothing to improve the outcome for our patient [7,8]. Still, such information interferes with what we have worked so hard to achieve and have come to expect in interventional cardiology-a picture-perfect result. In an era when final angiograms look so good that you want to show your friends, it takes fortitude and faith to let a lesion lie. But let there be no doubt, lesions do lie-particularly the jailed side branch (SB).To its credit, the jailed SB has been through a lot. It used to be the center of attention, getting T-stented, culotted, crushed, and kissed, but now, we attend to it only provisionally [9,10]. We have learned that the jailed SB, despite its angiographic appearance, is more often than not physiologically unimpeded, and that it will stay that way over time [11,12]. In fact, if wooed by a jailed SB that is not functionally significant, we could do more harm than good, causing vessel dissection that requires stenting, increasing the risk of restenosis and stent thrombosis, and interfering with the integrity of the main branch. For the jailed SB with a functionally significant stenosis (fractional flow reserve, FFR, <0.75), a simple kissing balloon inflation with a relatively small balloon (balloon/artery ratio <1) in the jailed SB is generally all that is needed for a good functional outcome.The basic finding in this month's study by Shin et al. is that when it comes to the significance of a jailed SB nothing and no one agrees with anything or anyone. Quantitative coronary angiography (QCA) core labs have poor agreement among themselves on which stenoses are 75%, and operators have poor agreement among themselves on the % stenosis, while QCA core labs and operators do not agree with each other, and neither is accurate in predicting FFR. In general, operators overestimate the % diameter stenosis and the functional significance of a jailed SB compared with QCA and FFR, respectively. In other words, as we have been shown over and over, the jailed SB is generally not as bad off as it wants us to think.It is interesting to ponder, then, what drives us to treat the jailed SB. It is not simply that we treat because we are inaccurate in our assessment of a lesions clinical severity. In this study, operators often (16.5% of the time) declared they would treat or not treat a jailed SB without regard to whether they thought the existing SB lesion was going to result in inducible myocardial ischemia. Most often (11.9%), it was operators deciding to treat a lesion even though they did not think it would cause inducible ischemia. Such discordance was more common among...