Wire Intact Yes No Advance microcatheter over wire as far a possible and pull Advance balloon over wire and inflate then pull Advance guide extension pin wire into extension with balloon and pull as a unit ID: 770011
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Wire Intact? Yes No Advance microcatheter over wire as far a possible and pull Advance balloon over wire and inflate, then pull Advance guide extension, pin wire into extension with balloon and pull as a unit Snare Cut with bioptome or atherectomy. Stent to pin to vessel wall Exits coronary? Pin to wall with stent Snare Drag out with balloon/guide extender No In the guide? Yes Yes Trap in guide with balloon and pull Snare No Stent Wire though it? No Yes Snare Double/Triple wire entanglement Drag into guide extension with balloon Stent into vessel wall Capture with bioptome OK to deploy? No Yes Deploy Is the wire intact and externalized through the guide? Is the wire fractured in the aorta (hanging out of the coronary)? Is delivery of the stent in the current position preferable to potential embolization or migration to a worse position in the coronary?
Microcatheters, balloons, laser tips, etc. Intact? Yes No Advance second wire/balloon and modify lesion Snare Cut shaft and deliver guide extension, pull as a unit Wire through it ? Yes No Advance second wire/balloon and modify lesion Snare Drag into guide extension with balloon Stent into vessel wall Can you get a wire past it? Yes No Drag into guide extension with balloon or snare Double/triple wire entanglement Advance second wire/balloon and modify lesion Abandon Surgery Is the device intact and externalized through the guide?
Atherectomy burr Intact? Yes No Gently push/pull advancer knob Increase RPMs ( rotablator ) and pull back advancer knob Lock in position and pull whole devicePull device and wire togetherGet a second wire past and modify lesion with balloon or laser Cut drive shaft, advance snare or guide extender over shaft Wire through it ? Yes No Drag out with snare via guide extension Double/triple wire entanglement Break wire, leave burr and stent into vessel wall Advance second wire/balloon and modify lesion Snare Drag into guide extension with balloonStent into vessel wall Can you get a wire past it? Yes No Abandon Surgery Is the device intact and externalized through the guide?