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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

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

Commonly Used Guidewires

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

  • 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.

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


HI-TORQUE BALANCE MIDDLEWEIGHT UNIVERSAL


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.

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.


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

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

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)


References


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