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FIG 1. Representative case of multistaged balloon inflation technique in a patient with left distal vertebral artery stenosis.
A, Pretreament angiogram shows a severely stenosed left distal vertebral artery at the site of posterior inferior cerebellar artery.
B, Angiogram shows the stent placed at the targeted lesion site; slow subnominal inflation (5 atm in this case) of the balloon was performed, with special consideration given to preventing "dog boning" of the proximal and distal ends of the balloon. Angiogram (not shown) was obtained to confirm the absence of a gap at the distal end of the stent.
C, Angiogram shows the balloon is carefully retrieved, with the proximal balloon marker (dotted arrow) placed outside the struts of the proximal end of the stent (solid arrow).
D, The balloon was slowly inflated to or above the nominal pressure, with special consideration given to avoiding any gap in the middle and proximal aspects of the stents. Repeat inflations were performed if any gap was visualized on the angiogram.
E, Final angiogram shows a well-positioned stent without gaps.
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