Problem
Solution
Balloon catheter will not move forward despite advancing it
This may be consequent to the guide catheter losing its position and dropping back into the ECA, CCA, or further proximally
• Locate the tip of the Guide catheter. In case it has dropped down, loosen the hub of the RHV attached to the Guide catheter
• Remove the redundancy in the system by pulling back the balloon catheter and wire concurrently, until the loops are gone and the system is straightened out
• Advance the guide catheter over the microcatheter and microwire back into its intended position
Unable to cross the lesion with the balloon catheter
• Use a smaller size balloon catheter to cross the lesion
• Perform angioplasty to ‘pre-dilate’ the lesion
• Then, re-attempt deployment of the balloon catheter of intended size
Disconnection of inflation device during angioplasty
• Attach large barrel syringe to balloon (side) port of catheter and aspirate to completely deflate balloon prior to withdrawal
Lack of flow distal to angioplasty on f/u angiography. This is probably due to acute vasospasm caused by the angioplasty
• Maintain wire access across the lesion
• Rapidly deploy the stent across the lesion
• Consider repeating the angioplasty
Proximal portion/tip of guidewire contaminated by touching unsterile surface, e.g., the injector or IV poles during angioplasty
The maintenance of wire access across the lesion is imperative. Therefore, the wire must not be withdrawn and discarded
• Use an alcohol swab to wipe off the exposed wire. As extra precaution, repeat wipe with a second swab
Problems Encountered During Stenting and Solutions
Table 11.2 shows some problems and solutions during angioplasty.
Table 11.2
Problems/solutions during stenting
Problem | Solution |
|---|---|
Difference in size of vessel proximal and distal to stent | • Choose a stent using the larger size measured, e.g., basilar artery measures 4 mm and PCA is 2 mm. The size of the stent should be ≥4 mm |
Resistance in advancing the stent system | • Ensure the system is straight to remove any excessive tension build up in the system. Slightly retract the stent system and guidewire to remove any tension or redundancy • Check that the guide catheter is positioned adequately to support the system. If not, advance it forward • If there are any loops in the stent system, straighten them out • Use a soft (floppy) guidewire which enables easy maneuverability of the stent system rather than the more firm support guidewires • Ensure that the flush system is functioning • Once the stent system is advancing, continue to advance it even if it goes distal to the lesion because it is easier to move the system from distal to proximal location than vice versa • If inordinate resistance continues despite corrective maneuvers, consider possibility of damage to the guidewire from use and discard it for a new wire. At the same time, examine and consider replacing the stent system with a new one as well |
Feeling of resistance during deploying stent | • Some resistance is usually encountered and expected. However, if the resistance is excessive, check to ensure the entire system is straight and there is no tension buildup. Slightly retract the system and guidewire to remove excessive tension • Check the position of the guide catheter to ensure that it is providing adequate support. If not, advance it further up. • If excessive tension persists, consider discarding the stent system and replacing it with a new system. If deployment is already underway, do not attempt to re-sheath the stent. Complete the deployment |
Loss of position during deployment | • If the stent has migrated distally, it may be possible to carefully pull back the entire system as deployment is taking place until it is back in the desirable location. Then, continue with the deployment. If any difficulty is encountered in the retraction, just deploy the stent in its current location. Then, deploy a second stent to cover the desired location
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