The importance of reducing traction while coming through stenotic areas can not be overemphasized. If there is a large amount of traction on the balloon catheter coming through the stenosis, it will recoil as it clears the tight area and the thrombus can be lost below the balloon again. In addition, this sudden catheter motion can cause dissections or other plaque disruption resulting in iatrogenic injury. If thrombus does migrate below the balloon, it can often be visualized in the column of contrast agent that is often pulled behind the balloon catheter as it is withdrawn. If this is seen, it is important to repeat the balloon pass before restoring flow.
If the first pass of the balloon from the distal popliteal to the proximal arteriotomy is productive of thrombus/embolus and there is no suspicion that the apposition of the balloon to the vessel was lost on the way up, a completion angiogram can be performed after this single passage. Replace the balloon catheter in the proximal popliteal artery and perform an arteriogram across the knee joint and into the tibials.
Link to this frame from your Personal Thumbnails page?