Step 1 - Select the Report (Diagram) Type:

Select the type of report desired by selecting:

'File' → 'Report Heading'.

Figure 1: Selecting a report type.

Step 2 – Set Templates and Basic Native Anatomy:

The reporting process begins during the angiogram itself. Attention should be paid to dominance, type of LAD, patterns of side-branches in the anterior, marginal, and posterolateral regions of the free LV wall, as well as anomalous vessel origins and pathways. The CARAT construction process is based upon the sequential selection of templates that most closely resemble the patterns observed during the angiogram or the angiographic review.

The template groupings are filed under the tabs seen along the top of the right portion of the screen.

The initial, 'Welcome' screen asks if the operator wishes to begin by using complete or partial default renderings. The default options have some advantages, but it is recommended that the 'Proceed Without Defaults' option be used until the operator is familiar with the tab sequence.

With each successive selection, a new set of templates is presented, and the most appropriate of these are selected by a left mouse-click. As the selection process proceeds, a picture progressively emerges on the drawing area to the left. It is not necessary to follow the tab sequence as presented.

The template options are loosely organized by branch location and branch size (the size number reflects the approximate number of segments from the 17-segment model supplied by the branch). Hovering the mouse pointer over an option opens a mouse-over box which describes the option.

Finally, options that reflect an anomalous origin or pathway of a segment or branch are shown on a yellow background.

Once the basic anatomy is decided upon, options are available to further refine side-branch and segment detail. These options can be seen by right-clicking on the segment that you wish to change. (In the example shown, the operator is contemplating branching a size two posterolateral branch.

Branch editing will be discussed in more detail in a subsequent tutorial.

Figure 2a: The CARAT welcome screen.

Figure 2b: Refining side-branch detail.

Step 3 – Locate the CARAT Taskbar:

The 'CARAT Task Bar' is located along the lower perimeter of the window.

It is helpful to refer to this area should you become stuck and need a hint on how to proceed. The lower-left corner reminds you which 'Edit Mode' you are in, while the section to the right tells you what the functions of the left and right mouse buttons are in this mode.

To exit the 'Edit Mode', right-click on an open area on the diagram.

Figure 3a: The CARAT taskbar highlighted at bottom right.

Figure 3b: The CARAT taskbar close-up.

Step 4 – Begin Entering Arterial Detail:

When the basic, native anatomy is decided upon, disease and intervention detail can be entered. This descriptive function is initiated by right-clicking the mouse on the drawing area (but not on the artery segments). A menu list is revealed as shown, and a desired item is selected by left-clicking the desired item (in this example the 'Lesion Edit Mode').

The lesion (or other menu selection) is placed upon the diagram by clicking and holding the left mouse button as the disease element/stent is 'drawn' along the vessel. This must be done from proximal to distal.

In addition, caution must be taken to make sure that the mouse button is activated and released within the boundaries of the artery. When working in small spaces, the 'Zoom' function can be extremely helpful - Use your mouse's scroll function to do so.

Step 5 – Locate the Secondary Menus:

In most cases, a secondary, drop-down menu is available for each menu item identifying options for greater item detail. (The example given is the 'Lesion' sub-menu).

A lesion severity of 50% is selected by default, but this value can be subsequently changed to any of the options shown.

In addition, tertiary submenus are available to identify culprit lesions and reasons for this decision, CTO features, FFR measurements, and Lesion Feature detail. These tertiary menus are opened by left-clicking the desired item and then right-clicking on the features for details that you wish to record.

Step 6 – Place Surgical Grafts:

Surgical graft placement is facilitated by selecting 'Grafts' on the main edit menu. When this selection is made, available graft targets are shown on the diagram.

At this point, the desired graft target is selected by a mouse right-click, revealing the graft-type options available. The graft-type option selection is made with a mouse left-click.

This topic is dealt with in more detail in a separate tutorial.

Step 7 – Draw Stents:

Stents are drawn, proximal to distal, using the left mouse button.

After the stent is placed, a detailed accounting of the stenting procedure can be documented by using the 'Stent Procedure Detail' drop-down menu:

Place your cursor on the stent and then right-click, revealing 'Stent Procedure Detail'. Left-clicking on this will display the 'Stent Procedure Detail Menu'. Complete as desired. Entries from this menu will be displayed as a 'Stent Summary' on the report.

This topic is dealt with in more detail in a separate tutorial.

Figure 7a: The stent procedure detail menu.

Figure 7b: The stent procedure accounting summary.