COOK Medical Evolution Gebrauchsanweisung Seite 10

Stent Placement
1. Remove the protective tubing from stent.
2. Using fluoroscopic guidance, introduce and advance the introduction
system in short increments over the pre-positioned wire guide into the
esophagus.
3. To ensure that the stent will bridge stricture after deployment,
fluoroscopically position radiopaque markers on inner catheter beyond
extremities of stricture to be crossed.
4. Confirm desired stent position fluoroscopically and to enable stent deployment
remove the red safety guard from the handle. (Figure 1)
5. Continue deploying stent by squeezing the trigger. NOTE: Each trigger squeeze will
deploy the stent by an equal amount.
6. If stent repositioning is required during deployment, it is possible to
recapture the stent. NOTE: It is not possible to recapture the stent after passing
point-of-no-return, indicated when the red marker on top of the introducer has
passed the point-of-no-return indicator on the handle. (Figure 2)
7. To recapture the stent, push the direction button on the side of the delivery system to
the opposite side. (Figure 3)
NOTE: Hold thumb on button when squeezing the trigger for the first time to
recapture.
8. Continue squeezing the trigger as required, to recapture the stent by desired
amount.
9. To resume deployment, push the button to the opposite side again and hold
thumb on the button for first stroke while squeezing the trigger. (Figure 4)
10. When stent point-of-no-return has been passed, pull and remove the safety wire
completely out of the delivery handle near the wire guide port to allow full stent
deployment. (Figure 5)
11. Continue deploying the stent by squeezing the trigger.
12. After deployment, fluoroscopically confirm full stent expansion. Once full expansion is
confirmed, the introduction system and wire guide can be safely removed.
NOTE: You may introduce endoscope and advance to the upper margin of the stent to
endoscopically confirm position and patency of the stent.
WARNING: Do not introduce the endoscope into the stent, as displacement may
occur.
Stent Repositioning Technique
To reposition the stent directly after placement, grip either the proximal or distal-end green
lasso with forceps and reposition the stent to the desired area. (Figure 6)
Stent Removal Technique (Benign Indications Only)
1. Locate the proximal and distal-end green lasso of the stent by direct endoscopic
visualization.
2. With forceps, gently apply tension to each green lasso to mobilize the distal and then
the proximal end of the stent from the esophageal wall. (Figure 7)
3. Once the stent has been mobilized, grasp the green lasso at proximal end of stent
securely and pull gently to collapse proximal end of stent and gently remove the
stent. (Figure 8)
Post Procedure
• Observe the patient for development of any complications of endoscopy, esophageal
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