Guidewire
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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
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
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 Guidewires
Peripheral Arterial Guidewires
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)