ABSTRACT
There are only two reasons to cross an occlusive arterial lesion. The first is to set up a therapeutic intervention. The second reason to cross a lesion is because this may be the best option for evaluating that lesion (i.e., by measuring pressure) and the surrounding vasculature (e.g., no other reasonable route to perform an arteriogram). Guidewire advancement is performed deliberately but gently. The principles of guidewire handling are presented in chapter 5. In the present chapter, these principles are applied in concept and practice to the management of occlusive lesions. The ideally placed guidewire will “dance” across the lesion. Negotiating guidewire passage across a reluctant arterial segment leads to a rewarding sense of accomplishment.
