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Figure 2 :This series of diagrams illustrates the principles involved in optimizing the approach of a penetrating guidewire across vascular occlusions. A straight approach allows for the most penetrating pressure at the tip of the guidewire (a). If the occluded vessel comes off at a relatively sharp angle (i.e., the "neo" left pulmonary artery in a Glenn shunt), attempts to apply force with a guidewire through a catheter will result in the catheter being pushed away (b). This results in minimal force at the tip of the guidewire. The addition of a coaxial system (c) allows for a supporting catheter (i.e., guide catheter) to be buttressed against the vessel wall, in a stable position. This facilitates the application of enough force at the guidewire tip to cross the occluded segment

Figure 2 :This series of diagrams illustrates the principles involved in optimizing the approach of a penetrating guidewire across vascular occlusions. A straight approach allows for the most penetrating pressure at the tip of the guidewire (a). If the occluded vessel comes off at a relatively sharp angle (i.e., the