First, the 'Edit Menu' is opened by right-clicking on a free part of the drawing area.

'Stent' is then selected, and the 'Stent Edit Mode' is shown to be active in the lower left corner of the screen. Click and hold the left mouse button and trace the first stent, proximal to distal, from the proximal LAD into the proximal diagonal. The stent being edited or described is shown in pink (Figure 1); stents that are inactive and not being modified are shown in blue

The next step is to right-click on the stent and select 'Stent Procedure Detail', opening the 'Stent Devices' menu (also shown in Figure 1). You are now ready to document the sequence of events during the Culotte procedure.

Predilatation of the proximal LAD and proximal diagonal lesions is performed and documented by selecting 'Balloon' under 'Device Type'; select the balloon used from the drop-down menu and enter diameter, length, and pressure detail.

Figure 1.

Next, 'Add' is selected, the 'Device Type' is changed to 'Stent', and 'Device Model' and parameters are entered as shown (Figure 2).

Figure 2.

The final step (with respect to this stent) is to post-dilate. This is documented by selecting 'Add' from the 'Multiple Devices' section, and then 'Balloon' under 'Device Type'.

Again, balloon particulars are entered, all as shown in Figure 3.

When done, select 'OK'.

Figure 3.

The second stent is then drawn from a point close to the heel of the previous stent, but now extending past the second LAD lesion (Figure 4).

Again, the 'Stent Procedure Detail' option is selected after right-clicking on the new stent. The first step to document is the pre-dilatation by selecting 'Balloon' and entering the balloon deployment particulars, as shown in Figure 4.

Next, 'Add' is selected and 'Stent' is chosen as the 'Device Type'. Once again, the 'Device Model' and deployment details are entered, as in Figure 5.

Finally, the post-dilatation balloon is documented by selecting 'Add', then selecting 'Balloon', then finally selecting the Device 'Model' and deployment particulars.

At this point, we also want to document that this was indeed a bifurcation procedure and we wish to specify the technique used. 'Culotte' is selected in the 'Bifurcation' drop-down menu, and we will specify that a Kissing Balloon procedure was used by checking the appropriate box.

All of the information entered is now carefully tabulated in the 'Stent and Balloon Tables' in the upper left portion of the report, whileother important information on the technique used is automatically recorded in the 'Comments' section below.

Figure 7.

Balloon Angioplasty (POBA) Documentation

Interventional procedures that do not use a stent are entered in a different way. Specifically, this is accomplished while in the 'Lesion Edit Mode', rather than the 'Stent Edit Mode'.

The lesion intervened upon is right-clicked and the 'Devices (no stent)' option is selected as shown in Figure 8 for this mid-circumflex 80% lesion.

The 'Lesion Devices' menu box opens, allowing entry of the procedure detail in a manner similar to that described for stenting (Figure 9).

Atherectomy is included in the 'Device Type' options, as it was in the 'Stenting' menu, as well. 'Guide Wire' is also included so that procedures where a guide wire is passed but a device cannot or was not inserted can be documented.