Prevention and treatment of coronary catheter kinking.

Coronary catheter kinking is an uncommon but potentially catastrophic complication of cardiac catheterization. Although simple maneuvers can often result in resolution of a kink, tighter knots may not respond to such measures. We provide a systematic, stepwise approach to the prevention and treatment of catheter kinking.

An algorithmic approach to balloon-uncrossable coronary lesions.

Balloon uncrossable coronary lesions are lesions that cannot be crossed with a balloon after successful guidewire crossing. The strategies used to facilitate the treatment of such lesions can be classified into strategies that provide lesion modification and strategies that increase support. We describe a systematic, algorithmic approach to treat balloon uncrossable lesions, starting with use of small balloons, followed by increase in guide catheter support, use of microcatheters, wire cutting or puncture techniques, laser, atherectomy, and subintimal modification techniques. Sequential and simultaneous application of the aforementioned techniques can result in successful treatment of these challenging lesions.