ABSTRACT
The challenge to any endovascular operator is posed by the lesions that are encountered. There are three general types of lesions facing every endovascular specialist: lesions that the guidewire sails across easily, lesions that require multiple tricks to get across and lesions that seem impossible, almost no matter what is done. In general, it is better to go ahead and set up people platform to support the therapeutic maneuver, then cross the lesion and, after that, treat immediately. A stenotic lesion should be visualized with arteriography before attempting to cross it. Oblique projections may be required for a full evaluation. The tip of the selective catheter must provide substantial support to the guidewire despite being perpendicular to the aortic flow stream. Once the branch artery lesion has been crossed, subsequent placement of a guiding sheath may pull the guidewire from its location and back into the aorta.
