Push‐pull angioplasty: ACE balloon‐facilitated stent passage technique

Abstract

Improvements in interventional cardiology equipment have facilitated the treatment of more complex anatomies. Bulky stent transport systems and the inflexibility of stents have remained a limitation to the delivery of stents to distal, angulated, stiff, and calcified vessels. In order to provide the strongest guide backup, some vessel straightening, and a stiff rail over which the stent apparatus could be passed, an ACE balloon was advanced past the target lesion and used to trap the distal wire by gently inflating the ACE balloon at low pressure. Traction is then placed on the ACE catheter and the angioplasty guide wire at the touey valve insertion site. This procedure facilitates easy passage of angioplasty devices through challenging anatomies. In addition to the two case reports described, this technique has been used numerous other times with consistent success. Cathet. Cardiovasc. Intervent. 48:93-95, 1999.

Novel technique for stent delivery in tortuous coronary arteries: Report of three cases

“…Sometimes it is confounded by sharp angles created by bypass vein hook-ups. When conven- More support Smaller-caliber guide [3] Deep engagement Guidewire Ironman/PlatinumPlus or 0.018Љ wire More support Less support wire More flexible Bent wire [4] Obviates local wire bias Superstiff buddy wire [5] Straightens tortuosity Stent Bent stent [6,7] Aligns stent with tortuosity Inflate tip of balloon slightly, Bubble Stent [8] Improves Push-pull angioplasty with ACE balloon [9] Better fixed support; straightens tortuosity Proximal stenting [10] Alters approach anatomy Constant forward pressure with deep breath Reduces tortuosity Our technique Forward pressure with partial stent balloon inflation tional techniques of complex stent delivery fail, it is useful to have additional "bag of tricks" to convert a disappointing failure into a pleasing success. The technique of partial balloon inflation, while applying gentle forward pressure on the stent delivery system, achieves that by straightening the obstructing segment enough to allow stent passage to the distal target.…”

“…Quite often, however, the predilatation results are inadequate or there is a significant dissection or haziness that mandates a stent. Many techniques of stent delivery have been described for these difficult situations [3][4][5][6][7][8][9][10][11][12][13]. Still, seemingly impossible stent passage is occasionally encountered.…”