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

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.

Historical Perspective

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

General guidewire techniques | Guidewire Techniques to Cross a Chronic Total Occlusion | Guidewire Techniques to Cross an Angulated Lesion or Tortuous Vessel Segment

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 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 | Wisdom | 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

Iron Man | Asahi Grand Slam

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

Crossing 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

Stabilizer | Wiggle wire

Peripheral Arterial Guidewires

Spartacore | V 18

Guidewire Tourquing Device

List of Guidewires by Manufacturer

References


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