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
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
Support (steerability and trackability)
Soft guide wires
Asahi soft guidewire | Hi-torque balance
Moderate support
Wisper wire | Wisdom | High torque balance middle weight
Extra support
Choice PT extra support | PT Graphix Intermediate | Stabilizer | Hi-Torque balance heavy weight
Super extra support
Crossing profile
Simple lesions
Complex lesions and lesions in very tortuous vessels
Prowater | Choice PT | PT graphix intermediate
Chronic total occlusions
Cross it Series | Miracle bros series | Shinobi | Confianza
Device delivery wires
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)