Guidewire: Difference between revisions
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{{CMG}}; '''Associate Editor-In-Chief:''' Priyantha Ranaweera [mailto:pranawee@bidmc.harvard.edu]; | {{CMG}}; '''Associate Editor-In-Chief:''' Priyantha Ranaweera [mailto:pranawee@bidmc.harvard.edu]; | ||
'''''Key Words and Synonyms:''''' PCI guidewire | '''''Key Words and Synonyms:''''' PCI guidewire; angioplasty guidewire; coronary guidewire; steerable wire; steerable guidewire. | ||
== | ==Overview== | ||
Angioplasty guidewires are small, soft, flexible, lubricated, wires that act as a rail over which equipment such as an angioplasty balloon, a stent, or an intravascular ultrasound device can be delivered over into the coronary artery. Angioplasty guide wires were introduced in 1982 by doctors Simpson and Roberts. The introduction of coronary guidewires was a major advance as it allowed the angioplasty balloon to be a traumatically steered to the proper location. | |||
==[[Guidewire | ==[[Guidewire general techniques|Guidewire Techniques]]== | ||
==[[Guidewire complications|Guidewire Complications]]== | ==[[Guidewire complications|Guidewire Complications]]== | ||
==[[Guidewire | ==[[Guidewire desirable performance characteristics|Desirable Performance Characteristics of Coronary Guidewires]]== | ||
==Guidewire Design Features== | ==Guidewire Design Features== | ||
A guidewrie has three main components - a | A guidewrie has three main components - a core, a tip and a lubricous Coating. | ||
[[Image:Components_of_a_guide_wire.jpg]] | [[Image:Components_of_a_guide_wire.jpg]] | ||
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Figure : Components of a guide wire (courtesy : Abbott vascular inc) | Figure : Components of a guide wire (courtesy : Abbott vascular inc) | ||
[[Guidewire | [[Guidewire Core]] | [[Guidewire Coatings]] | [[Guidewire Tip]] | ||
[[Guidewire Core Diameters]] | Guidewire Wisdom | [[Guidewire Tip Diameters]] | [[Guidewire Lengths]] | |||
==Support ( | ==Guidewires Classified Based Upon Support (Steerability and Trackability)== | ||
===Soft | ===Soft Guidewires=== | ||
[[Guidewire Asahi soft| Asahi | [[Guidewire Asahi soft| Asahi Soft Guidewire]] | Hi-torque Balance | ||
===Moderate | ===Moderate Support Guidewires=== | ||
[[Guidewire wisper wire|Wisper | [[Guidewire wisper wire|Wisper Wire]] | [[Guidewire High torque balance middle weight|High Torque Balance Middle Weight]] | ||
===Extra | ===Extra Support Guidewires=== | ||
[[Guidewire choice PT extra support|Choice PT | [[Guidewire choice PT extra support|Choice PT Extra Support]] | PT Graphix Intermediate | Stabilizer | [[Guidewire hi-torque balance heavy weight|Hi-Torque Balance Heavy Weight]] | ||
===Super | ===Super Extra Support Guidewires=== | ||
[[Guidewire iron man|Iron Man]] | [[guidewire asahi grand slam|Asahi Grand Slam]] | [[Guidewire iron man|Iron Man]] | [[guidewire asahi grand slam|Asahi Grand Slam]] | ||
==Crossing | ==Guidewires Classified By Crossing Profile== | ||
===Complex lesions and lesions in very tortuous vessels=== | ===Complex lesions and lesions in very tortuous vessels=== | ||
[[Guidewire prowater|Prowater]] | [[Guidewire Choice PT|Choice PT]] | | [[Guidewire prowater|Prowater]] | [[Guidewire Choice PT|Choice PT]] | PT Graphix Intermediate | ||
===Chronic | ===Guidewires Used to Cross Chronic Total Occlusions=== | ||
[[ | Wires to be used in escalating order of aggressiveness: | ||
====First Choice==== | |||
'''Non-hydrophilic''' or '''hydrophobic''' wires with an '''intermediate stiffness''' are a good first choice as they have a better tactile response, are less likely to lead to a subintimal position than a hydrophilic wire, and may have an additional advantage in their ability to cross the proximal cap of the occlusion. Choices in this class include the [[Miracle Bros]] 3 and the [[Asahi intermediate wires]]. | |||
====Second Choice==== | |||
'''Hydrophilic''' wires may track better after the proximal cap of the occlusion has been crossed. Hydrophilic/coated wires have better maneuverability in [[tortuosity|tortuous]] or [[calcification|calcified]] vessels. '''Intermediate stiffness hydrophilic wire''' choices include the [[Choice PT XS (Extra Support)]], the [[Pilot 50]], the [[Pilot 100]] or the [[PT Graphix intermediate wire]]. | |||
== | ====Third Choice==== | ||
[[ | '''Stiff non-hydrophilic wires''': The [[Miracle Bros]] 6, 9 and 12, [[Cross-IT]], [[Confienza]], [[Persuader]] | ||
====Fourth Choice==== | |||
'''Stiff and hydrophilic (most aggressive)''': [[Pilot 200]] and [[Shinobi]] | |||
== | ==Device Delivery Guidewires== | ||
Guidewire wiggle wire- The wiggle wire has a niche role in delivering stents and balloons into areas with poor transmission of proximal push. The wiggle wire works by shifting the direction of the pushing forces thus "stepping over" the obstacle. | |||
== | ==Peripheral Arterial Guidewires== | ||
* Spartacore - The Spartacore is a peripheral arterial guidewire. | |||
* Guidewire V 18 | |||
==Guidewire Tourquing Device== | |||
A torquing device is a tool interventional cardiologists use to torque a coronary guidewire and to maintain the tension on the guidewire to preserve the torque and the direction the guidewire. There is a gradual inadvertent “unwinding” of torque when the human fingers are used to steer a coronary guidewire, and this unwinding can be effectively prevented by this tool. | |||
==[[List of Guidewires by Manufacturer]]== | |||
== | |||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
Latest revision as of 21:49, 28 January 2013
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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
Angioplasty guidewires are small, soft, flexible, lubricated, wires that act as a rail over which equipment such as an angioplasty balloon, a stent, or an intravascular ultrasound device can be delivered over into the coronary artery. Angioplasty guide wires were introduced in 1982 by doctors Simpson and Roberts. The introduction of coronary guidewires was a major advance as it allowed the angioplasty balloon to be a traumatically steered to the proper location.
Guidewire Techniques
Guidewire Complications
Desirable Performance Characteristics of Coronary Guidewires
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 Wisdom | Guidewire Tip Diameters | Guidewire Lengths
Guidewires Classified Based Upon Support (Steerability and Trackability)
Soft Guidewires
Asahi Soft Guidewire | Hi-torque Balance
Moderate Support Guidewires
Wisper Wire | High Torque Balance Middle Weight
Extra Support Guidewires
Choice PT Extra Support | PT Graphix Intermediate | Stabilizer | Hi-Torque Balance Heavy Weight
Super Extra Support Guidewires
Guidewires Classified By Crossing Profile
Complex lesions and lesions in very tortuous vessels
Prowater | Choice PT | PT Graphix Intermediate
Guidewires Used to Cross Chronic Total Occlusions
Wires to be used in escalating order of aggressiveness:
First Choice
Non-hydrophilic or hydrophobic wires with an intermediate stiffness are a good first choice as they have a better tactile response, are less likely to lead to a subintimal position than a hydrophilic wire, and may have an additional advantage in their ability to cross the proximal cap of the occlusion. Choices in this class include the Miracle Bros 3 and the Asahi intermediate wires.
Second Choice
Hydrophilic wires may track better after the proximal cap of the occlusion has been crossed. Hydrophilic/coated wires have better maneuverability in tortuous or calcified vessels. Intermediate stiffness hydrophilic wire choices include the Choice PT XS (Extra Support), the Pilot 50, the Pilot 100 or the PT Graphix intermediate wire.
Third Choice
Stiff non-hydrophilic wires: The Miracle Bros 6, 9 and 12, Cross-IT, Confienza, Persuader
Fourth Choice
Stiff and hydrophilic (most aggressive): Pilot 200 and Shinobi
Device Delivery Guidewires
Guidewire wiggle wire- The wiggle wire has a niche role in delivering stents and balloons into areas with poor transmission of proximal push. The wiggle wire works by shifting the direction of the pushing forces thus "stepping over" the obstacle.
Peripheral Arterial Guidewires
- Spartacore - The Spartacore is a peripheral arterial guidewire.
- Guidewire V 18
Guidewire Tourquing Device
A torquing device is a tool interventional cardiologists use to torque a coronary guidewire and to maintain the tension on the guidewire to preserve the torque and the direction the guidewire. There is a gradual inadvertent “unwinding” of torque when the human fingers are used to steer a coronary guidewire, and this unwinding can be effectively prevented by this tool.