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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]; |
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| '''''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. |
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| ==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 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. |
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| ==Historical Perspective== | | ==[[Guidewire general techniques|Guidewire Techniques]]== |
| 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.
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| ==Desirable Performance Characteristics of Coronary Guidewires== | | ==[[Guidewire complications|Guidewire Complications]]== |
| ===Steerability===
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| The tip of a coronary guidewire must be curved and must be able to be turned or "torqued" to follow the course of the vessel down which it is being placed.
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| ===Trackability===
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| A coronary guidewire must be capable of being readily advanced around curves in the coronary arteries, and must have sufficient strength or support to allow devices to likewise go around these curves in the coronary artery.
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| ===Torquability===
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| The tip of the guidewire must be able to be pointed in different directions by the operator to change directions, to go into sidebranches, to cross asymmetric or eccentric lesions, to avoid stent struts and to go around corners and bends in the coronary artery. When the operator rotates the guidewire outside the body, the ability of the guidewire to translate this motion into a similar motion at the tip is called torquability. This is the ability of the coronary guidewire to transmit rotational forces from the operators hand to the tip and the optimal performance is for this rotation of the coronary guidewire to be translated to the tip in a one-to-one fashion. The operator will often use his hand to twist or maneuver the wire, however, the torquability of the wire may be further improved by the use of a “torquer” or a “pin vise” or “steering tool”.
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| ===Support=== | | ==[[Guidewire desirable performance characteristics|Desirable Performance Characteristics of Coronary Guidewires]]== |
| The support of coronary guidewire refers to the ability of the coronary guidewire to allow a bulky device to track through bends in the coronary artery and to be to be delivered across the blockage without buckling or kinking of the wire. If the operator is attempting to advance a balloon or stent down the artery, and if the guiding catheter backs out of the coronary artery and if the guidewire also works its way from a distal position to a proximal position and backs out of the body, then this may be a sign of a "lack of guidewire support". Calcified and tortuous right coronary arteries often require guidewires that offer improved support to maneuver a balloon or a stent to a distal lesion in the right coronary artery.
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| ===Tactile Feedback=== | | ==Guidewire Design Features== |
| Tactile feedback refers to the “feel” of the wire tip’s behavior as perceived by the operator. Tactile feedback is better appreciated with coil tipped wires, whereas polymer tipped wires it may be minimal or absent, making inadvertent perforation, dissection or subintimal diversion into a plaque more likely.
| | A guidewrie has three main components - a core, a tip and a lubricous Coating. |
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| ===Stiffness===
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| Stiffness of the guidewire depends upon the diameter, trackability and torque control of the guidewire. Stiffer wires give better torque control and straighten the vectors of forces pushing the wire, balloon or a stent. Stiff quagmires may allow devices to be delivered through tortuous and calcified vessels with greater ease. A stiffer wire can be useful in crossing chronic total occlusions as well as when delivering a stent or balloon in a straight segment and can work against delivering a stent or balloon in a tortuous or an angulated segment. Stiffer wires are more likely to cause pleating artefacts and also slice through the intima in a “cheese cutter” effect. This "cheese cutter" effect has been observed with the "Iron Man" wire.
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| ====MALLEABILITY====
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| Ability to be shaped or bent without breaking
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| ====STEERABLE GUIDE WIRES====
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| =====FLEXIBILITY=====
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| Is the ability to bend with direct pressure.
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| Determined mainly by the distance from the tip of the central core to the distal tip of the wire.
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| Important in minimizing vascular trauma
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| ===RADIOOPACITY / VISIBILITY===
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| Useful as a marker, measure of length, helps maintain focus on the lesion while the tip is in the peripheral visual field.
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| Platinum at the end of the wire gives radio-opacity
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| May mask anatomy, eg dissection
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| ==CORONARY GUIDE WIRES==
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| ===SIZES===
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| ====CORE DIAMETER====
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| 0.010” - 0.018”
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| Commonest 0.014”
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| Some wires have tapering ends (eg .014” tapering to .010 “)
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| ====TIP DIAMETER====
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| Usually 0.014” – 0.009”
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| ====LENGTH====
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| Standard length : 175-190 cm
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| Exchange length : 270-400 cm
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| If using a standard length wire and need an exchange length wire, use a docking system to mount another standard length wire
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| (caution – docking joint is prone to “snapping” when bent, also the docking joint may give way)
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| 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. )
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| ===PHYSICAL CHARACTERISTICS===
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| Has three main components - Core, Tip and the lubricous coating.
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| [[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) |
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| 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]] |
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| ===CORE===
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| The core is usually ground to a taper towards the end for the tip to attach.
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| If core starts tapering more towards the tip, the wire as a whole becomes more rigid, steerable and torquable.
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| The opposite happens when the core tapers more proximally allowing for a longer tip.
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| The core may be continuous or joined (more likely to bend on wire advancement if joined)
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| ====COMPOSITION====
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| Nitinol, stainless steel or similar metal
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| ====TYPES OF CORE MATERIAL====
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| ====NITINOL====
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| [[Image:nitinol.jpg]] | |
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| ====ADVANTAGES - NITINOL====
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| Super-elastic alloy designed for kink resistance
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| Excellent flexibility and steering
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| Probably more durable nature
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| Better trackability
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| Less prolapse.
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| ====DISADVANTAGES - NITINOL===
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| Stores torque without necessarily transmitting it to the tip Wires with single nitinol cores could “ wind up”
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| Less torquable
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| ====CLINICAL CORRELATION - NITINOL====
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| Nitinol wires are more likely to enter a retroflexed circumflex
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| ====STAINLESS STEEL====
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| Original core material technology
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| [[Image:stainless_steel.jpg|(Courtesy of Abbott vascular)]]
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| ===ADVANTAGES – STAINLESS STEEL====
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| Gives more pushability, torquability, and good shapeability in “core-to-tip” wires.
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| Good support, push force and torque
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| ====DISADVANTAGES – STAINLESS STEEL====
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| *Tendency to kink
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| *Less flexible than newer core materials
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| ===OTHER MATERIAL USED IN THE CORE===
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| ===High tensile strength stainless steel===
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| [[Image:High_tensile_strength_stainless_steel.jpg]] | |
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| *More durable than regular stainless steel
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| *Retains shape more
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| *Improved flexibility
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| *Improved steering and tracking
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| ===Asahi Tru Torque Steel===
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| [[Image:Asahi_Tru_Torq_Steel.jpg]]
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| ==LUBRICIOUS COATING==
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| One or both of
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| *Hydrophilic
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| *Hydrophobic
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| *Hydrophobic tip and hydrophilic distal end
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| *Affects lubricity, friction and wire tracking in crossing lesions as well as during stent and balloon delivery.
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| *Facilitate smooth movement
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| *Confined to the distal 30-35 cm
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| ==Commonly used coatings==
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| 1.PTFE (Polytetrafluroehylene) - commonest
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| 2.Teflon
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| 3.Silicone
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| 4.Pro/Pel®, (Medtronic)
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| 5.Hydro-track® (Medtronic)
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| 6.Hydro-coat (Abbott vascular)
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| ===HYDROPHILIC COATING===
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| *attracts water
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| *It is applied over polymer or stainless steel (including tip coils)
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| *Thin, non-slippery solid when dry, needs lubrication to perform
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| *Becomes gel when wet
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| *Reduces friction
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| *Increases trackability
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| ===HYDROPHOBIC COATING===
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| *repels water
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| *Silicone on working area of wire, excluding tip
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| *No actuation/wetting required
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| *Reduces friction
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| *Increases trackability
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| Platinum in the tip for radio-opacity. (usually 3-25 cm length at the tip)
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| ===TIP OF THE INNER CORE WIRE===
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| ===CORE TO TIP GUIDE WIRES===
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| [[Image:core_to_tip.jpg]]
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| 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.
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| 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”
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| ===SHAPING RIBBON===
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| Softer tip allowing shape retention
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| [[Image:shaping_ribbon.jpg]]
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| ===TIP OF THE GUIDE WIRE===
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| ===SPRING COIL TIP===
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| 1. Spring coil - Safer than hydrophilic coated or polymer tip wires - less risk of perforation
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| 2. Distal weld
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| ===SPRING COILS===
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| *Outer coils only
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| [[Image:Spring_coil_outer_only.jpg]]
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| *Tip coil only
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| [[Image:Spring_coil_tip_only.jpg]]
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| [http://www.example.com link title]
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| ===TIP COVER===
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| *Polymer or plastic
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| *Provide lubricity
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| *Smooth tracking through tortuosity
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| [[Image:covers.jpg]]
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| =====POLYMER TIP (COVER)=====
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| Polymer instead of the spring coil with hydrophilic coating
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| Improved trackability with the compromise of reduced tactile feedback / feel
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| Eg: PT Graphix™ Intermediate Guide Wire, ChoICE PT wire
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| =====”COMBINATION” TIPS=====
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| *Tip coils plus
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| *Intermediate coils
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| *Bare core
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| *Plastic cover
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| *Polymer
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| *Polymer over tip coils
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| As lubricity increases the amount of tactile feedback decreases. This partly accounts for the increased risk of perforation with hydrophilic coated wires.
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| [[Image:Relationship_of_lubricity_to_tactile_feedback.jpg|thumb|350px]]
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| Courtesy: Abbott Vascular
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| =====TIP LOAD=====
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| 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.
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| Using this method , the tip loads in ascending order are 3gm, 4.5 gm, 6gm, 9 gm and 12 gm (ultra stiff)
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| As stiffness increases the wire becomes prone to perforation
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| =====FLEXIBILITY OF TIP=====
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| =====DETERMINANTS OF TIP FLEXIBILITY=====
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| =====JOINT=====
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| There is one or more joints in the wires with tip material some different to core material.
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| 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.
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| [[Image:Joint_wire_bends.jpg]] | |
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| ===[[COMMONLY USED GUIDEWIRES]]===
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| There is no uniform clinical classification of guide wires.
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| A commonly used somewhat crude classification is based on
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| 1. Support ( steerability and trackability. )
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| =====Soft guide wires=====
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| *Asahi soft
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| *Hi-torque balance
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| =====moderate support=====
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| *Wizdom
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| *High torque balance middle weight
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| =====extra support=====
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| *ChoICE PT extra support
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| *PT Graphix intermediate
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| *Stabilizer
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| *Hi-torque balance heavy weight
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| =====Super extra support=====
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| *Iron man
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| *Asahi grand slam
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| 2. Crossing profile
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| 2.1 Simple lesions
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| 2.2 Complex lesions and lesions in very tortuous vessels
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| *Prowater
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| *ChoICE PT
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| *PT graphix intermediate
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| 2.3 Chronic total occlusions
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| *Cross it series
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| *Miracle bro series
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| *Shinobi
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| *Confianza
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| 3. Device delivery wires
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| *Stablizier
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| *Wiggle
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| ===[[COMMONLY USED GUIDE WIRES]]===
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| ===ASAHI SOFT / LIGHT GUIDE WIRE===
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| [[Image:Asahi_soft.jpg]]
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| *Hydrophobic Coating
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| *Soft tip
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| *Flexible body
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| *Support to deliver most interventional devices
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| *Tip load: 0.5 g
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| *Radiopaque length: 3 cm
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| *Outside diameter: 0.014"
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| *Total length: 180 cm – 300 cm
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| ===ASAHI PROWATER AND PROWATER FLEX===
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| Relatively safe guide wire with moderate support.
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| [[Image:Asahi_prowater_and_prowater_flex.jpg]]
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| Source : http://www.abbottvascular.com/
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| *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.
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| *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.)
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| *Tip load: 0.8 g
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| *Radiopaque length: 3 cm
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| *Outside diameter: 0.014"
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| *Total length: 180 cm, 300 cm
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| ===ACS HI TORQUE BALANCED MIDDLE WEIGHT (BMW)===
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| ===ACS HIGH TORQE BALANCE MIDDLE WEIGHT (BMW) UNIVERSAL===
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| Shaping ribbon provides reasonable provision for shape retention & tip softness
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| Intermediate coils at the tip maintain .014" diameter for smooth device delivery
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| *Hydrophobic or Hydrophilic coating for tracking
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| [[Image:Asahi_Tru_Torq_Steel.jpg]]
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| ====HI-TORQUE BALANCE MIDDLEWEIGHT UNIVERSAL====
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| [[Image:BMW_universal.jpg]]
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| Durasteel shaping ribbon material provides added durability and shape retention
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| Intermediate section has both a hydrophilic coating and a polymer cover
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| ===PT GRAPHIX INTERMEDIATE===
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| Figure Source http://www.bostonscientific.com
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| ===ChoICE PT ===
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| Excellent in crossing moderately difficult lesions and negotiating tortuous lesions.
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| [[Image:CPT.jpg]]
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| Crossing guide wire with light rail support.
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| Unibody stainless steel
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| Polymer tip
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| Hydrophilic ICE coating
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| Radioopaque length 35 cm
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| Outside diameter 0.014”
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| Available lengths182cm, 300 cm
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| Compatible with magnet Exchange Device
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| ===ChoICE PT Extra support===
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| Crossing guide wire with extra rail support
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| Figure CPT XS jpg
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| Unibody stainless steel
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| Polymer tip
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| Hydrophilic ICE coating
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| Radioopaque length 35 cm
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| Outside diameter 0.014”
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| Available lengths 182cm, 300 cm
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| Compatible with Magnet Exchange Device
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| ===ChoICE Floppy guide wire===
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| Relatively atraumatic guide wire with light rail support.
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| Figure Choice jpg
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| Unibody stainless steel
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| Spring tip, polymer sleeve
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| ICE hydrophilic coating
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| Radioopaque length 3 cm
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| Outside diameter 0.014”
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| Available lengths 182cm, 300 cm
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| Compatible with Magnet Exchange Device
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| ===ChoICE Extra support===
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| Delivery support wire with extra rail support.
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| [[Image:CPT_XS.jpg]]
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| =====BASIC CONSTRUCTION=====
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| Unibody stainless steel core
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| Spring tip, Polymer sleeve
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| ICE hydrophilic coating
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| Radioopaque length 3 cm
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| Outside diameter 0.014”
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| Available lengths 182cm, 300 cm
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| Compatible with Magnet Exchange Device
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| ====WHISPER====
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| [[Image:Whisper.jpg]]
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| Durasteel™ Core-to-tip designed to improve steering, durable shape retention and tactile feedback
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| Full Polymer cover with Hydrophilic coating intended for deliverability and smooth lesion access
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| Responsease™ “transitionless” core grind designed to provide improved tracking and better torque response
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| Tip coils designed to provide softer, shapeable tip and also improve tactile feedback
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| ====STABILIZER EXTRA SUPPORT====
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| ==== WIZDOM====
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| :
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| :
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| =====WIGGLE WIRE=====
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| 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".
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| =====IRON MAN GUIDEWIRE=====
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| 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.
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| ===GUIDE WIRES PRIMARILY USED FOR CHRONIC TOTAL OCCLUSIONS===
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| ===CROSS IT GUIDE WIRES===
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| 1. CROSS IT XT 100
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| Cross it 100 xt
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| Figure source: http://www.abbottvascular.com
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| Tapered tip coil from 0.014" to 0.010" at distal 3 cm
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| Hydrocoat hydrophilic coating of distal 30 cm
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| :
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| 2. Cross it 200 XT
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| Cross it 200 xt
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| 3. Cross it 300 XT
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| Cross it 300 xt
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| ===PILOT WIRES===
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| ===Pilot 50, 150, 200===
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| Figure
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| :
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| ====PERSUADER ====
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| These wires are mainly used to cross challenging chronic total occlusions
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| Core to tip family used mainly for CTOs
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| Figures source http://www.medtronic.com
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| =====PERSUADER 3====
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| Persuader 3jpg
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| ====PERSUADER 6====
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| Persuader 6jpg
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| ====PERSUADER 9====
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| Persuader 9jpg
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| ===ASAHI MIRACLE BRO===
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| These wires are mainly used to cross challenging chronic total occlusions
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| Core to tip guidewires
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| ===ASAHI MIRACLE BRO 3===
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| 1. Asahi miraclebros 3.JPG
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| Tip load: 3 g
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| Radiopaque length: 11 cm
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| Outside diameter: 0.014"
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| Total length: 180 cm
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| 2. Asahi Miraclebro 4.5
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| Asahi miraclebros 45.JPG
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| Tip load: 4.5 g
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| Radiopaque length: 11 cm
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| Outside diameter: 0.014"
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| Total length: 180 cm
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| 3. Asahi Miraclebro 6
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| Asahi miraclebros 6.JPG
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| Tip load: 6 g
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| Radiopaque length: 11 cm
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| Outside diameter: 0.014"
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| Total length: 180 cm
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| 4. Asahi Miraclebro 12
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| Asahi miraclebros 12.JPG
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| Tip load: 12 g
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| Radiopaque length: 11 cm
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| Outside diameter: 0.014"
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| Total length: 180 cm
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| =====STEEL CORE=====
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| ===ZINGER GUIDEWIRE===
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| ===COUGAR GUIDEWIRE===
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| ===THUNDER GUIDEWIRE===
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| =====ASAHI GRAND SLAM=====
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| The tip is very flexible, hence less traumatic, but provides considerable support.
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| Tip load: 0.7 g
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| Radiopaque length: 3 cm
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| Outside diameter: 0.014"
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| Total length: 180 cm, 300 cm
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| Asahi grand slam jpg.
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| =====SPARTACORE=====
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| This wire is mainly used in peripheral interventions.
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| =====V 18=====
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| 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.
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| ====STEERABLE GUIDE WIRES====
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| ====Cordis ATW™ All Track Wire====
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| FIG CORDIS STEERABLE GUIDE WIRE
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| Moderate Support
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| General Purpose
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| Precision Control from Hand to Tip
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| Precise steerability for lesion access
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| Enhanced flexibility for tracking in tortuous vessels
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| Highly lubricious, durable platform for smooth delivery of multiple devices
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| The ATWTM Guidewire atraumatic floppy tip and integrated FLEX-JOINTTM Bond combine for distal flexibility and atraumatic vessel tracking
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| ==== Torquer / steering tool====
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| 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.
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| Two types are commonly used.
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| ====TIPS IN CROSSING A LESION====
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| 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.
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| 2. If a wire repeatedly fails to cross a lesion,
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| a. Adjust the guide,
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| b. Use a balloon, transit, ultrafuse or twin pass catheter to direct the wire
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| c. modify the bend at the tip.
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| d. change the wire ( check the tip of the wire for evidence of wear and tear)
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| 3. A wire in a balloon or a catheter ( ultrafuse, transit or exchelon) may help guide the wire through the lesion
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| ==SAFETY TIPS==
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| 1. Get used to a few wires to suit most situations
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| 2. Always use the least traumatic wire for the lesion, >90% lesions could be crossed with standard “work horse” wires
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| 3. Until familiar and comfortable, do not rush in to wires which are mote likely to perforate.
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| 4. Avoid bending or buckling the wire
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| 5. Never push a wire, let it find its “track” with
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| 6. A ventricular premature beat could be a suggestion that the wire is off track, withdraw the wire immediately and redirect it.
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| 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.
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| 8. If there is a suspicion of a perforation, then an emergent Echo should be performed on the table. ( link complications – perforation)
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| ==COMMON PITFALLS==
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| ==TROUBLE SHOOTING==
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| ===TRAPPED WIRE ===
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| May occur with
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| *calcified vessels ( eg RCA) at the tip.
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| May be prevented by avoiding using the same wire on multiple interventions or multiple crossing.
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| My need to advance a small profle balloon or a small caliber catheter (transit) to the “attachement” site and use traction. Caution : Perforation.
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| * 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.
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| ===DETACHMENT OR EMBOLISATION OF END OF THE WIRE===
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| Uncommon with most modern wires.
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| ====Management====
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| There is no data to guide management. Clinical judgment should be used.
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| May have to snare it.
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| 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.
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| Surgery may be needed.
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| ===WIRE FRACTURE IN A CORONARY VESSEL===
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| This should be identified immediately and the wire should be replaced. It could give rise to the situations mentioned above.
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| ==GUIDEWIRES BY MAJOR MANUFACTURERS==
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| ===Abbott vascular===
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| 1.1 Asahi
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| *Asahi by Abbott vascular
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| *ASAHI Confianza Coronary Guide Wires
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| *ASAHI Grand Slam Coronary Guide Wires
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| *ASAHI Light Coronary Guide Wires
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| *ASAHI Medium Coronary Guide Wires
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| *ASAHI Miracle Bros Coronary Guide Wires (3g, 4.5g, 6g and 12g)
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| *ASAHI Prowater Coronary Guide Wires
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| *ASAHI Prowater Flex Coronary Guide Wires
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| *ASAHI Standard Coronary Guide Wires
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| 1.2 Balance wires by Abbott vascular
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| BALANCE (HI-TORQUE BALANCE Coronary Guide Wire)
| | [[Guidewire Core Diameters]] | Guidewire Wisdom | [[Guidewire Tip Diameters]] | [[Guidewire Lengths]] |
| BALANCE (HI-TORQUE BALANCE MIDDLEWEIGHT UNIVERSAL Coronary Guide Wire)
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| 1.3 HI-TORQUE CROSS-IT XT Coronary Guide Wire by Abbott vascular
| | ==Guidewires Classified Based Upon Support (Steerability and Trackability)== |
| *100 XT
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| *200 XT
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| *300 XT
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| ===Medtronic=== | | ===Soft Guidewires=== |
| *Cougar
| | [[Guidewire Asahi soft| Asahi Soft Guidewire]] | Hi-torque Balance |
| *Zinger
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| *Persuader
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| *Thunder
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| ===Boston Scientific=== | | ===Moderate Support Guidewires=== |
| | [[Guidewire wisper wire|Wisper Wire]] | [[Guidewire High torque balance middle weight|High Torque Balance Middle Weight]] |
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| Crossing guide wires
| | ===Extra Support Guidewires=== |
| *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]] |
| *ChoICE PT Extra support
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| *PT
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| *PT Graphix Intermediate
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| *Forte
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| *IQ
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| *Luge
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| *Mailman
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| 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”
| | ===Super Extra Support Guidewires=== |
| | [[Guidewire iron man|Iron Man]] | [[guidewire asahi grand slam|Asahi Grand Slam]] |
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| ===cordis=== | | ==Guidewires Classified By Crossing Profile== |
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| *ATW™All Track Wire
| | ===Complex lesions and lesions in very tortuous vessels=== |
| *ATW™Marker Wire
| | [[Guidewire prowater|Prowater]] | [[Guidewire Choice PT|Choice PT]] | PT Graphix Intermediate |
| *WIZDOM® Steerable Guidewires
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| *WIZDOM® ST Steerable Guidewires
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| *STABILIZER® Balanced Performance Steerable Guidewires
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| *STABILIZER® Plus Steerable Guidewires
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| *STABILIZER® XS Steerable Guidewires
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| *STABILIZER® Marker Wire
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| *SHINOBI® Steerable Guidewires
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| *SHINOBI® Plus Steerable Guidewires
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| *REFLEX® Steerable Guidewires
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| *Steer it Deflecting Tip Guidewire E-1
| | ===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]]. |
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| Steerable Guidewire Accessories
| | ====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]] |
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| *CINCH® QR Extension Wire
| | ==Device Delivery Guidewires== |
| *EASY TWIST® Torquing Device
| | 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. |
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| | ==Peripheral Arterial Guidewires== |
| | * Spartacore - The Spartacore is a peripheral arterial guidewire. |
| | * Guidewire V 18 |
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| ==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. |
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| 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]]== |
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| 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
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| ==References==
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| {{Reflist|2}}
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| [[Category:Cardiology]] | | [[Category:Cardiology]] |
