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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Priyantha Ranaweera [2];
Key Words and Synonyms: PCI guidewire, angioplasty guidewire, coronary guidewire, steerable wire, steerable guidewire
Overview
Historical Perspective
Desirable Performance Characteristics of Coronary Guidewires
Guidewire Complications
Steering the Guidewire
Guidewire Design Features
A guidewrie has three main components - a Core, a Tip and a Lubricous Coating.
Figure : Components of a guide wire (courtesy : Abbott vascular inc)
Guidewire core | Guidewire coatings
Guidewire core diameters | Guidewire tip diameters | Guidewire lengths
List of Guidewires by Manufacturer
TIP OF THE INNER CORE WIRE
CORE TO TIP GUIDE WIRES
When the core is extended to the tip, that increases pushability, precise steering, tip control and torquability. This can be a useful feature for eg. in probing chronic total occlusions.
With unibody wires there is more torquability, pushability and tactile feel. With two piece tip wires shaping is easy and the wire is likely to retain the shape “wire memory”
SHAPING RIBBON
Softer tip allowing shape retention
TIP OF THE GUIDE WIRE
SPRING COIL TIP
1. Spring coil - Safer than hydrophilic coated or polymer tip wires - less risk of perforation
2. Distal weld
SPRING COILS
- Outer coils only
- Tip coil only
TIP COVER
- Polymer or plastic
- Provide lubricity
- Smooth tracking through tortuosity
POLYMER TIP (COVER)
Polymer instead of the spring coil with hydrophilic coating
Improved trackability with the compromise of reduced tactile feedback / feel
Eg: PT Graphix™ Intermediate Guide Wire, ChoICE PT wire
”COMBINATION” TIPS
- Tip coils plus
- Intermediate coils
- Bare core
- Plastic cover
- Polymer
- Polymer over tip coils
As lubricity increases the amount of tactile feedback decreases. This partly accounts for the increased risk of perforation with hydrophilic coated wires.
Courtesy: Abbott Vascular
TIP LOAD
One way of quantifying some of these physical features is by measuring with a strain gauge, the force needed to bend a wire when exerted on a straight guide wire tip, at 1 cm from the tip.
Using this method , the tip loads in ascending order are 3gm, 4.5 gm, 6gm, 9 gm and 12 gm (ultra stiff)
As stiffness increases the wire becomes prone to perforation
FLEXIBILITY OF TIP
DETERMINANTS OF TIP FLEXIBILITY
JOINT
There is one or more joints in the wires with tip material some different to core material.
The number of joints and the nature of them influence the clinical performance of the wires. The joints could serve as hinge points and bend during guide wire passage.
COMMONLY USED GUIDEWIRES
There is no uniform clinical classification of guide wires.
A commonly used somewhat crude classification is based on
1. Support ( steerability and trackability. )
Soft guide wires
- Asahi soft
- Hi-torque balance
moderate support
- Wizdom
- High torque balance middle weight
extra support
- ChoICE PT extra support
- PT Graphix intermediate
- Stabilizer
- Hi-torque balance heavy weight
Super extra support
- Iron man
- Asahi grand slam
2. Crossing profile
2.1 Simple lesions
2.2 Complex lesions and lesions in very tortuous vessels
- Prowater
- ChoICE PT
- PT graphix intermediate
2.3 Chronic total occlusions
- Cross it series
- Miracle bro series
- Shinobi
- Confianza
3. Device delivery wires
- Stablizier
- Wiggle
COMMONLY USED GUIDE WIRES
ASAHI SOFT / LIGHT GUIDE WIRE
- Hydrophobic Coating
- Soft tip
- Flexible body
- Support to deliver most interventional devices
- Tip load: 0.5 g
- Radiopaque length: 3 cm
- Outside diameter: 0.014"
- Total length: 180 cm – 300 cm
ASAHI PROWATER AND PROWATER FLEX
Relatively safe guide wire with moderate support.
Source : http://www.abbottvascular.com/
- Has a hybrid Coating: Soft hydrophobic tip & hydrophilic working coils. Hydrophilic coating maximizes lubricity to navigate anatomy and hydrophobic coating designed to enhance tactile feel.
- Uses “TruTorq” technology - a design that fuses stainless steel to platinum spring coils via a single-joint. (claimed to afford the improved torque response and steerability seen with this wire.)
- Tip load: 0.8 g
- Radiopaque length: 3 cm
- Outside diameter: 0.014"
- Total length: 180 cm, 300 cm
ACS HI TORQUE BALANCED MIDDLE WEIGHT (BMW)
ACS HIGH TORQE BALANCE MIDDLE WEIGHT (BMW) UNIVERSAL
Shaping ribbon provides reasonable provision for shape retention & tip softness
Intermediate coils at the tip maintain .014" diameter for smooth device delivery
- Hydrophobic or Hydrophilic coating for tracking
HI-TORQUE BALANCE MIDDLEWEIGHT UNIVERSAL
Durasteel shaping ribbon material provides added durability and shape retention
Intermediate section has both a hydrophilic coating and a polymer cover
PT GRAPHIX INTERMEDIATE
Figure Source http://www.bostonscientific.com
ChoICE PT
Excellent in crossing moderately difficult lesions and negotiating tortuous lesions.
Crossing guide wire with light rail support.
Unibody stainless steel Polymer tip Hydrophilic ICE coating Radioopaque length 35 cm Outside diameter 0.014” Available lengths182cm, 300 cm Compatible with magnet Exchange Device
ChoICE PT Extra support
Crossing guide wire with extra rail support
Figure CPT XS jpg
Unibody stainless steel Polymer tip Hydrophilic ICE coating Radioopaque length 35 cm Outside diameter 0.014” Available lengths 182cm, 300 cm Compatible with Magnet Exchange Device
ChoICE Floppy guide wire
Relatively atraumatic guide wire with light rail support.
Figure Choice jpg
Unibody stainless steel Spring tip, polymer sleeve ICE hydrophilic coating
Radioopaque length 3 cm Outside diameter 0.014” Available lengths 182cm, 300 cm Compatible with Magnet Exchange Device
ChoICE Extra support
Delivery support wire with extra rail support.
BASIC CONSTRUCTION
Unibody stainless steel core Spring tip, Polymer sleeve ICE hydrophilic coating Radioopaque length 3 cm Outside diameter 0.014” Available lengths 182cm, 300 cm Compatible with Magnet Exchange Device
WHISPER
Durasteel™ Core-to-tip designed to improve steering, durable shape retention and tactile feedback
Full Polymer cover with Hydrophilic coating intended for deliverability and smooth lesion access
Responsease™ “transitionless” core grind designed to provide improved tracking and better torque response
Tip coils designed to provide softer, shapeable tip and also improve tactile feedback
STABILIZER EXTRA SUPPORT
WIZDOM
:
:
WIGGLE WIRE
This wire has a niche role in delivering stents and balloons in to areas with poor transmission of proximal push. It works by shifting the direction of the pushing forces thus "stepping over" the :obstacle".
IRON MAN GUIDEWIRE
Stiff wire with poor steerability. Its rigidness is used to straighten vessel segements and allow better transmission of forces pushing balloons or stents. This property comes from the tendency of the wire to retain its shape rather than conform to the contours of the vessel. This feature makes “cheese cutter” effects on the vascular intima at their bends. This some times is demonstrated angiographically by a “pleating artifact” and in extreme situations could lead to a transient “no-reflow” state. ( Figure) Though this wire will allow transmit more force to the balloon or the stent, it could actually make device delivery more difficult in tortuous vessels.
GUIDE WIRES PRIMARILY USED FOR CHRONIC TOTAL OCCLUSIONS
CROSS IT GUIDE WIRES
1. CROSS IT XT 100
Cross it 100 xt
Figure source: http://www.abbottvascular.com
Tapered tip coil from 0.014" to 0.010" at distal 3 cm
Hydrocoat hydrophilic coating of distal 30 cm
:
2. Cross it 200 XT
Cross it 200 xt
3. Cross it 300 XT
Cross it 300 xt
PILOT WIRES
Pilot 50, 150, 200
Figure :
PERSUADER
These wires are mainly used to cross challenging chronic total occlusions
Core to tip family used mainly for CTOs
Figures source http://www.medtronic.com
=PERSUADER 3
Persuader 3jpg
PERSUADER 6
Persuader 6jpg
PERSUADER 9
Persuader 9jpg
ASAHI MIRACLE BRO
These wires are mainly used to cross challenging chronic total occlusions Core to tip guidewires
ASAHI MIRACLE BRO 3
1. Asahi miraclebros 3.JPG
Tip load: 3 g Radiopaque length: 11 cm Outside diameter: 0.014" Total length: 180 cm
2. Asahi Miraclebro 4.5
Asahi miraclebros 45.JPG
Tip load: 4.5 g
Radiopaque length: 11 cm
Outside diameter: 0.014"
Total length: 180 cm
3. Asahi Miraclebro 6
Asahi miraclebros 6.JPG
Tip load: 6 g Radiopaque length: 11 cm Outside diameter: 0.014" Total length: 180 cm
4. Asahi Miraclebro 12
Asahi miraclebros 12.JPG
Tip load: 12 g Radiopaque length: 11 cm Outside diameter: 0.014" Total length: 180 cm
STEEL CORE
ZINGER GUIDEWIRE
COUGAR GUIDEWIRE
THUNDER GUIDEWIRE
ASAHI GRAND SLAM
The tip is very flexible, hence less traumatic, but provides considerable support. Tip load: 0.7 g Radiopaque length: 3 cm Outside diameter: 0.014" Total length: 180 cm, 300 cm
Asahi grand slam jpg.
SPARTACORE
This wire is mainly used in peripheral interventions.
V 18
This is a .018” wire mainly used in the peripheral interventions. It is a stiff wire with excellent torque control, tendency to prolapse and perforation.
STEERABLE GUIDE WIRES
Cordis ATW™ All Track Wire
FIG CORDIS STEERABLE GUIDE WIRE
Moderate Support General Purpose Precision Control from Hand to Tip Precise steerability for lesion access Enhanced flexibility for tracking in tortuous vessels Highly lubricious, durable platform for smooth delivery of multiple devices The ATWTM Guidewire atraumatic floppy tip and integrated FLEX-JOINTTM Bond combine for distal flexibility and atraumatic vessel tracking
TIPS IN CROSSING A LESION
1. Use a bend at the tip of the wire which is roughly the length of the diameter of the vessel proximal to the lesion. 2. If a wire repeatedly fails to cross a lesion, a. Adjust the guide, b. Use a balloon, transit, ultrafuse or twin pass catheter to direct the wire c. modify the bend at the tip. d. change the wire ( check the tip of the wire for evidence of wear and tear) 3. A wire in a balloon or a catheter ( ultrafuse, transit or exchelon) may help guide the wire through the lesion
SAFETY TIPS
1. Get used to a few wires to suit most situations 2. Always use the least traumatic wire for the lesion, >90% lesions could be crossed with standard “work horse” wires 3. Until familiar and comfortable, do not rush in to wires which are mote likely to perforate. 4. Avoid bending or buckling the wire 5. Never push a wire, let it find its “track” with 6. A ventricular premature beat could be a suggestion that the wire is off track, withdraw the wire immediately and redirect it. 7. Check every fluro and cine loop for evidence for perforation, embolization and dissection. If the picture quality is poor, then do not hesitate to increase the frame count/radiation to improve it. 8. If there is a suspicion of a perforation, then an emergent Echo should be performed on the table. ( link complications – perforation)