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c) A sphincterotomy and predilatation of the biliary stricture
may be performed prior to stent implantation at the
discretion of the physician.
d) Remove safety cylinder and stylet before loading guidewire.
e) Insert the trailing end of the guidewire through the tip of the
delivery system and advance in short strokes until it exits
the guidewire access port. The guidewire access port allows
the guidewire to exit the delivery system approximately
30cm from the tip of the device. The guidewire then lies
along the side of the delivery system.
f) Advance the system over the guidewire. Unlock the wire to
pass the stent into the scope.
g) Lock the guidewire into place and continue advancing the
system through the scope until the stent is in the desired
location.
④ Stent Deployment Procedure
PRECUATION: Do not twist introducer system or employ a
boring motion during the deployment as this may affect
positioning and ultimate function of stent.
a) Under the fluoroscope and/or endoscopic guidance, position the
introducer system to the center of the target stricture exactly.
b) Once the introducer system is in the correct position for
deployment, unlock the proximal valve of the Y-connector by
turning the valve more than twice in an anti-clockwise direction.
c) To begin stent deployment, immobilize the hub in one hand and
grasp the Y-connector with the other hand. Gently slide the Y-
connector back along the pusher towards the hub.
d) When the center X-ray marker reaches the center of target
stricture, continue pulling back on the Y-connector until the
stent is fully deployed. (See figure 3, 4)
CAUTION Do not push forward or pull backward on the hub
with the stent partially deployed. The hub must be securely
immobilized. Inadvertent movement of the hub may cause
misalignment of the stent and possible damage to bile duct.
The Y and T-Type stents may be deployed under fluoroscope or
endoscopically, however, the T & Y-Type stents have larger
interstices within the central mesh which are detailed by larger
radiopaque markers. A second stent may be placed within these
larger interstices in order to ensure coverage and drainage of two
or more ducts. The central radiopaque marker should ideally be
placed at the point of the bifurcation.
⑤ After Stent Deployment
a) Examine the stent fluoroscopically and/or endoscopically to
confirm expansion.
b) Carefully remove the introducer system, guidewire and
endoscope from the patient. If excessive resistance is felt
during removal, wait 3~5 minutes to allow further stent
Figure 3
Figure 4
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