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
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