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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, angioplasty guidewire, coronary guidewire, steerable wire, steerable guidewire
'''''Key Words and Synonyms:''''' PCI guidewire; angioplasty guidewire; coronary guidewire; steerable wire; steerable guidewire.


==[[Guidewire overview|Overview]]==
==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 historical perspective|Historical Perspective]]==
==[[Guidewire general techniques|Guidewire Techniques]]==
 
==[[Guidewire complications|Guidewire Complications]]==


==[[Guidewire desirable performance characteristics|Desirable Performance Characteristics of Coronary Guidewires]]==
==[[Guidewire desirable performance characteristics|Desirable Performance Characteristics of Coronary Guidewires]]==


==CORONARY GUIDE WIRES==
==Guidewire Design Features==
 
A guidewrie has three main components - a core, a tip and a lubricous Coating.  
===SIZES===
 
====CORE DIAMETER====
 
0.010” - 0.018”
Commonest 0.014”
Some wires have tapering ends (eg .014” tapering to .010 “)
 
====TIP DIAMETER====
 
Usually 0.014” – 0.009”
 
====LENGTH====
 
Standard length : 175-190 cm
Exchange length : 270-400 cm
 
If using a standard length wire and need an exchange length wire, use a docking system to mount another standard length wire
 
(caution – docking joint is prone to “snapping” when bent, also the docking joint may give way)
 
When using an exchange length wire and delivering a balloon or a stent, a magnet may be used to hold the wire in place. (preferably this is a two operator procedure. )
 
===PHYSICAL CHARACTERISTICS===
 
Has three main components - Core, Tip and the 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)


In some wires the core extends up to the tip. In others the tip is made of a different material
[[Guidewire Core]] | [[Guidewire Coatings]] | [[Guidewire Tip]]
 
===CORE===
 
The core is usually ground to a taper towards the end for the tip to attach.
 
If core starts tapering more towards the tip, the wire as a whole becomes more rigid, steerable and torquable.
 
The opposite happens when the core tapers more proximally allowing for a longer tip.
 
The core may be continuous or joined (more likely to bend on wire advancement if joined)
 
====COMPOSITION====
 
Nitinol, stainless steel or similar metal
 
====TYPES OF CORE MATERIAL====
 
====NITINOL====
 
[[Image:nitinol.jpg]]
 
====ADVANTAGES - NITINOL====
 
Super-elastic alloy designed for kink resistance
Excellent flexibility and steering
Probably more durable nature
Better trackability
Less prolapse.
 
====DISADVANTAGES - NITINOL===
 
Stores torque without necessarily transmitting it to the tip  Wires with single nitinol cores could “ wind up”
 
Less torquable
 
====CLINICAL CORRELATION - NITINOL====
 
Nitinol wires are more likely to enter a retroflexed circumflex
 
====STAINLESS STEEL====
 
Original core material technology
 
[[Image:stainless_steel.jpg|(Courtesy of Abbott vascular)]]
 
===ADVANTAGES – STAINLESS STEEL====
 
Gives more pushability, torquability, and good shapeability in “core-to-tip” wires.
Good support, push force and torque
 
====DISADVANTAGES – STAINLESS STEEL====
 
*Tendency to kink
*Less flexible than newer core materials
 
===OTHER MATERIAL USED IN THE CORE===
 
===High tensile strength stainless steel===
[[Image:High_tensile_strength_stainless_steel.jpg]]
 
*More durable than regular stainless steel
*Retains shape more
*Improved flexibility
*Improved steering and tracking
 
===Asahi Tru Torque Steel===
[[Image:Asahi_Tru_Torq_Steel.jpg]]
 
==LUBRICIOUS COATING==
 
One or both of
 
*Hydrophilic
*Hydrophobic
*Hydrophobic tip and hydrophilic distal end
 
*Affects lubricity, friction and  wire tracking in crossing lesions as well as during stent and balloon delivery.
 
*Facilitate smooth movement
 
*Confined to the distal 30-35 cm
 
==Commonly used coatings==
 
1.PTFE (Polytetrafluroehylene) - commonest
 
2.Teflon
 
3.Silicone
 
4.Pro/Pel®, (Medtronic)
 
5.Hydro-track® (Medtronic)
 
6.Hydro-coat (Abbott vascular)
 
===HYDROPHILIC COATING===
 
*attracts water
*It is applied over polymer or stainless steel (including tip coils)
*Thin, non-slippery solid when dry, needs lubrication to perform
*Becomes gel when wet
*Reduces friction
*Increases trackability
 
===HYDROPHOBIC COATING===
 
*repels water
*Silicone on working area of wire, excluding tip
*No actuation/wetting required
*Reduces friction
*Increases trackability
 
Platinum in the tip for radio-opacity. (usually 3-25 cm length at the tip)
 
===TIP OF THE INNER CORE WIRE===
 
===CORE TO TIP GUIDE WIRES===
[[Image:core_to_tip.jpg]]
 
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
[[Image:shaping_ribbon.jpg]]
 
===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
[[Image:Spring_coil_outer_only.jpg]]
*Tip coil only
[[Image:Spring_coil_tip_only.jpg]]
 
[http://www.example.com link title]
 
===TIP COVER===
 
*Polymer or plastic
*Provide lubricity
*Smooth tracking through tortuosity
 
[[Image:covers.jpg]]
 
=====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.
 
[[Image:Relationship_of_lubricity_to_tactile_feedback.jpg|thumb|350px]]
 
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.
 
 
[[Image:Joint_wire_bends.jpg]]
 
 
 
 
===[[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===
 
 
[[Image:Asahi_soft.jpg]]
 
*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.
 
[[Image:Asahi_prowater_and_prowater_flex.jpg]]
 
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
 
 
[[Image:Asahi_Tru_Torq_Steel.jpg]]
 
====HI-TORQUE BALANCE MIDDLEWEIGHT UNIVERSAL====
 
 
[[Image:BMW_universal.jpg]]
 
 
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.
 
[[Image:CPT.jpg]]
 
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.
 
 
[[Image:CPT_XS.jpg]]
 
=====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====
[[Image:Whisper.jpg]]
 
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
 
==== Torquer / steering tool====
 
Used to maintain an achieved torque. There is a gradual inadvertent “unwinding” of torque with human fingers which can be effectively prevented by this tool.
 
Two types are commonly used.
 
====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)
 
 
==TROUBLE SHOOTING==
 
 
===TRAPPED WIRE ===
 
May occur with
 
*calcified vessels ( eg RCA) at the tip.
 
May be prevented by avoiding using the same wire on multiple interventions or multiple crossing.
 
My need to advance a small profle balloon or a small caliber catheter (transit) to the “attachement” site and use traction. Caution : Perforation.
 
* May occur when a buddy wire gets trapped between a stent and the vessel wall. Gentle traction may bring the wire out of the stent. The coating of the tip may “deglove” and be left behind, which could be “pushed and pasted” against the vessel wall with another stent. May need surgery to retrieve it. The tip may completely detach, then the management is as above.
 
===DETACHMENT OR EMBOLISATION OF END OF THE WIRE===
 
Uncommon with most modern wires.
 
====Management====
 
There is no data to guide management. Clinical judgment should be used.
 
May have to snare it.
 
May be left in situ, speacially if small and unable to retrieve. Could use a stent to “push and paste” it to the vessel wall.
 
Surgery may be needed.
 
===WIRE FRACTURE IN A CORONARY VESSEL===
 
This should be identified immediately and the wire should be replaced. It could give rise to the situations mentioned above.
 
 
==GUIDEWIRES BY MAJOR MANUFACTURERS==
 
===Abbott vascular===
 
1.1 Asahi
 
*Asahi by Abbott vascular
*ASAHI Confianza Coronary Guide Wires
*ASAHI Grand Slam Coronary Guide Wires
*ASAHI Light Coronary Guide Wires
*ASAHI Medium Coronary Guide Wires
*ASAHI Miracle Bros Coronary Guide Wires (3g, 4.5g, 6g and 12g)
*ASAHI Prowater Coronary Guide Wires
*ASAHI Prowater Flex Coronary Guide Wires
*ASAHI Standard Coronary Guide Wires


1.2 Balance wires by Abbott vascular
[[Guidewire Core Diameters]] | Guidewire Wisdom | [[Guidewire Tip Diameters]] | [[Guidewire Lengths]]


BALANCE (HI-TORQUE BALANCE Coronary Guide Wire)
==Guidewires Classified Based Upon Support (Steerability and Trackability)==
BALANCE (HI-TORQUE BALANCE MIDDLEWEIGHT UNIVERSAL Coronary Guide Wire)  


1.3 HI-TORQUE CROSS-IT XT Coronary Guide Wire by Abbott vascular
===Soft Guidewires===
*100 XT
[[Guidewire Asahi soft| Asahi Soft Guidewire]] | Hi-torque Balance
*200 XT
*300 XT


===Medtronic===
===Moderate Support Guidewires===
*Cougar
[[Guidewire wisper wire|Wisper Wire]] | [[Guidewire High torque balance middle weight|High Torque Balance Middle Weight]]
*Zinger
*Persuader
*Thunder


===Boston Scientific===
===Extra Support Guidewires===
[[Guidewire choice PT extra support|Choice PT Extra Support]] | PT Graphix Intermediate | Stabilizer | [[Guidewire hi-torque balance heavy weight|Hi-Torque Balance Heavy Weight]]


Crossing guide wires
===Super Extra Support Guidewires===
*ChoICE PT
[[Guidewire iron man|Iron Man]] | [[guidewire asahi grand slam|Asahi Grand Slam]]
*ChoICE PT Extra support
*PT
*PT Graphix Intermediate
*Forte
*IQ
*Luge
*Mailman


mailman.jpg, Delivery support guidewire super support rail for straightening of vessel. Spring tip with polymer sleeve, unibody stainless steel, hydrophilic coating 3 cm radioopacity, diameter .014”
==Guidewires Classified By Crossing Profile==


===Cordis===
===Complex lesions and lesions in very tortuous vessels===
[[Guidewire prowater|Prowater]] | [[Guidewire Choice PT|Choice PT]] | PT Graphix Intermediate


*ATW™All Track Wire
===Guidewires Used to Cross Chronic Total Occlusions===
*ATW™Marker Wire
Wires to be used in escalating order of aggressiveness:
*WIZDOM® Steerable Guidewires
====First Choice====
*WIZDOM® ST Steerable Guidewires
'''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]].
*STABILIZER® Balanced Performance Steerable Guidewires
====Second Choice====
*STABILIZER® Plus Steerable Guidewires
'''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]].
*STABILIZER® XS Steerable Guidewires
*STABILIZER® Marker Wire
*SHINOBI® Steerable Guidewires
*SHINOBI® Plus Steerable Guidewires
*REFLEX® Steerable Guidewires


*Steer it Deflecting Tip Guidewire E-1
====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]]


Steerable Guidewire Accessories
==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.


*CINCH® QR Extension Wire
==Peripheral Arterial Guidewires==
*EASY TWIST® Torquing Device
* Spartacore - The Spartacore is a peripheral arterial guidewire.
* Guidewire V 18


==Sources==
==Guidewire Tourquing Device==
1. Arce-Gonzalez JM, Schwartz L, Ganassin L, Henderson M, Aldridge H: Complications associated with the guide wire in percutaneous transluminal coronary angioplasty. J Am Coll Cardiol 10: 218-221, 1987.
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.


2. Hartzler GO, Rutherford BD, McConahay DR: Retained percutaneous transluminal coronary angioplasty equipment components and their management. Am J Cardiol 60:1260-1264, 1987.
==[[List of Guidewires by Manufacturer]]==


3. Serota H, Deligonul U, Lew B, Kern MJ, Aguirre F, Vandomael M: Improved method for transcatheter retrieval of intracoronary detached angioplasty guidewire segments. Cathet Cardiovasc Diagn 17:248-251, 1989. 218-221, 1987


==References==
{{Reflist|2}}


[[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

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

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.

List of Guidewires by Manufacturer


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