Guidewire

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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 tip

Guidewire core diameters | Guidewire tip diameters | Guidewire lengths

List of Guidewires by Manufacturer

Commonly Used Guidewires

Support (steerability and trackability)

Soft guide wires

Asahi soft guidewire | Hi-torque balance

Moderate support

Wisper wire | Wisdom | 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

Crossing profile

Simple lesions

Complex lesions and lesions in very tortuous vessels

Prowater | Choice PT | PT graphix intermediate

Chronic total occlusions

Cross it Series | Miracle bros series | Shinobi | Confianza

Device delivery wires

Stabilizer | Wiggle wire

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)


References


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