10. Stingray

For Stingray to be successful, it should be used early before any subintimal space expansion has occurred from wire manipulation. When using antegrade wire escalation technique, the first time the wire has gone pass the distal cap into subintimal space, instead of redirecting the wire, corsair or cross boss should be used to make space for stingray balloon and stingray performed. The exceptions to this is when there is a large side branch of bifurcation at the distal cap or when tthere are features suggestive that stingray will be less likely to be successful (9). Parallel wire with IVUS guide wiring should be used in these circumstances. For less experienced operators, Cross boss should be used to make a long subintimal track and a miracle 12 wire used to exchange the stingray balloon, but for experienced operators who can keep wire position well during exchanges, the corsair can be used to dilate up the wire path and stingray balloon placed just beyond the distal cap for re-entry puncture.