Guidewire: Difference between revisions
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===Guidewires Used to Cross Chronic Total Occlusions=== | ===Guidewires Used to Cross Chronic Total Occlusions=== | ||
[[Treatment of chronic total occlusions|Crossing Chronic Total Occlusions]] | [[Treatment of chronic total occlusions|Crossing Chronic Total Occlusions]] | ||
Wires to be used in escalating order of aggressiveness: | |||
:* '''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]]. | |||
:* '''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]]. | |||
:* Shaping the wire tip using a modest angulation is better for blunted stump occlusions. | |||
:* A low-profile balloon or exchange catheter adds back-up support for wire penetration of fibro-calcific caps and may also be used cautiously for balloon-assisted progression within the occlusion. | |||
:* Intra-luminal position of the wire distal to the occlusion is suggested by a freely rotating wire tip or angiography in different views by distal catheter or contralateral injections. | |||
:* Stiffer wire tips will allow for a greater chance of crossing the proximal cap of the occlusion at the cost of an increased risk of vessel [[dissection]] or [[perforation]]. | |||
::* '''Stiff non-hydrophilic wires''': The [[Miracle Bros]] 6, 9 and 12, [[Cross-IT]], [[Confienza]], [[Persuader]] | |||
::* '''Stiff and hydrophilic (most aggressive)''': [[Pilot 200]] and [[Shinobi]] | |||
[[Guidewire cross it series|Cross it Series]] | [[Guidewire miracle bros series|Miracle bros series]] | [[Guidewire shinobi|Shinobi]] | [[Guidewire confianza|Confianza]] | [[Guidewire cross it series|Cross it Series]] | [[Guidewire miracle bros series|Miracle bros series]] | [[Guidewire shinobi|Shinobi]] | [[Guidewire confianza|Confianza]] | ||
Revision as of 23:32, 23 October 2011
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WikiDoc Resources for 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
Guidewire techniques
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
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
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:
- 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.
- 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.
- Shaping the wire tip using a modest angulation is better for blunted stump occlusions.
- A low-profile balloon or exchange catheter adds back-up support for wire penetration of fibro-calcific caps and may also be used cautiously for balloon-assisted progression within the occlusion.
- Intra-luminal position of the wire distal to the occlusion is suggested by a freely rotating wire tip or angiography in different views by distal catheter or contralateral injections.
- Stiffer wire tips will allow for a greater chance of crossing the proximal cap of the occlusion at the cost of an increased risk of vessel dissection or perforation.
Cross it Series | Miracle bros series | Shinobi | Confianza
Device Delivery Guidewires
Peripheral Arterial Guidewires