1) The document discusses different guidewires that are needed for crossing chronic total occlusions, including their specifications and appropriate clinical uses. 2) It emphasizes having a range of guidewires with different tip loads and properties for tasks like antegrade and retrograde wiring, collateral crossing, and re-entry. 3) The conclusion recommends knowing the properties of a limited set of key guidewires and using simple algorithms when starting, as no wire can find the way without skilled steering from the operator.

1. EURO CTO CLUB
Toulouse 2018
Wires, what we need, what we
have and next future
J.Dens, ZOL Genk, Belgium
EuroCTO, Toulouse, 2018

2. What we need: the best wires to…
Antegrade and retrograde wiring
Collateral crossing: septal & epicardial
Antegrade and retrograde knuckling
Re-direction and re-entry
Guiding entry, externalisation, tip-in

3. Why we need the best wires?
Can I wire this? Can I cross this collateral?

4. Current wire-technology allows unexpected
success but still is inpredictable
Gaia II crosses antegradely… Suoh crosses collateral…

5. Wiring ante & retrogradely:
the path from A to B or B to A is clear
 ”loose tissue tracking”
 Tapered tip, low tip load, lubricity: Fielder family (0.6 -1.0 g), Fighter family (1.5 g)
 “hard cap/tissue penetration” (puncture)
 Tapered tip, high tipload: Confianza (= Conquest pro 9-12), Hornet 14, Provia 15, Progress T 200
 Can be followed by de-ascalation
 “directional tracking”
 Gaia family (1.7-4.5 g)(Miracle, Progress…)

6. Tipload and penetration force
tipload Penetration force

7. Name
Diameter*
inch/
mm
Tip
Diameter*
*
inch/mm
Length
(cm)
Coil
length
(cm)
Radiopaque
(cm)
Tip Load
(gf)
Core
Material
Tip
Shape
Coating
FIGHTER
0.014/
0.37
0.009/
0.23
190
300
18 3.5 1.5
Stainless
Steel
Straight
Polymer
Jacket w/
Hydrophilic
Fielder XT-A
0.014/
0.37
0.010/
0.26
190
300
16 16 1.0
Stainless
Steel
Straight
Polymer
Jacket w/
Hydrophilic
Fighter versus XT-A
FIGHTER™
4.5gHydrophilic Coating
0.014 inch*
PTFE Coating
Radiopaque (3.5 cm)
0.009inch**
Polymer (Coil) Length (18cm)
Polymer jacket & SLIP-COAT™ coating (17cm)
Radiopaque Spring Coil (16
cm)
0.014inch*
PTFE CoatingHydrophilic Coating
0.010inch**
Fielder
™
XT-A
03-AA JAN2016
FielderXTisTrademarkofASAHIINTECCCO.,LTD.DataASAHIwebpage.

8. Directional wires

9. High tipload/penetration force wires
Confianza (Conquest) Hornet
PTFE
Coating
3.5 cm
radiopaque
15 cm
hydrophilic
coating
15 cm
spring
coil
0.008”
Diamet
er*
Compound taper
stainless steel core
0.014”
Diameter*
Compatible w/
STRETCH Extension
Wire
Tip Load Hornet 10: 10g, PF (gf/mm2
) 308
Tip Load Hornet 14: 14 g, PF (gf/mm2
) 432

10. Wiring ante & retro:
the track from A to B or B to A is unclear
 To remain within the architecture:
 Intermediate tipload, polymeric, “slippery”:
Ultimate 3
Pilot 200 (4 gram)
 Gladius (4 gram with a compound core: increased rotational and tip bend
stiffness)

11. Use “easy” step-up algorythms, ante- and retrograde
“Asahi algorythm”
 Fielder XT-A
 Gaia II vs Ultimate 3
 Confianza pro 12
“US algorythm”
 Fighter
 Pilot 200
 Hornet 14
Get used to your basic wires

12. Crossing septal collaterals
 Invisible channel:
 Sion, XT-R, Sion black…alternative for Sion = Samourai RC
 Continuous tortuosity
 Sion, Suoh 3, Fielder XT-R, Sion black
 Side branches and bends
 Sion, Suoh 3, XT-R, Sion black
 Acute bends
 Suoh 3, Sion, XT-R, Sion black

13. SAMURAI™ RC Specialty Crossing
Guidewire
PTFE Coating4 cm
radiopaqu
e
24 cm hydrophilic
coating
24 cm
spring coil
0.014”
Diameter*
Compound taper
stainless steel core
0.014”
Diameter*
Compatible w/ STRETCH
Extension Wire
1. Exceptional torque performance
without whipping
2. Outstanding durability and tip shape
retention
Hydrophilic Coating
&
Enhanced Flexibility
Designed for collateral crossing &
excellent tracking to access distal lesions
I.C.T.
Inner Coil
Technolog
y
Tip Load
(gf)
Radio-
paque
Length
Outer
Diameter
Tip Style Cover
Coil
Length
Distal
Coating
Core
Material
Rail
1.2 4 cm
0.014”
0.37mm
I.C.T.
Spring
Coil
24 cm Hydrophilic
Stainless
Steel
Moderate

14. Crossing epicardials
 Suoh 3
 Sion
 Rarely XT-R knuckle…

15. Knuckling ante & retro
 Non-directed blunt dissection to cross long trajects within the vessel architecture:
 “smaller, softer”
 Filelder family, Fighter…
 “larger, stronger”, power-knuckles
 Pilot 200, Gladius
 “very strong”
 Gaia, confianza…
 Knuckle: umbrella-like or larger bend which will flip over

16. Re-direction and re-entry
 Re-direction:
 Intermediate to high tipload and directional
 Gaia II-III, confianza, hornet, progress, Pilot…
 Re-entry to true lumen (via double lumen MC, Stingray…):
 High tipload
 Stingray wire, Gaia III, Confianza, Hornet…Astato 20 (off label)
 Re-entry to true lumen via reverse CART
 Low to intermediate tipload

17. Re-entry in guiding, externalisation and
tip-in
 Guiding re-entry:
 If still substantial true lumen tract: soft wires
 If close to re-entry: intermediate, slippery wires
 Externalisation:
 Extra lenght, low shaft bend stifness
 RG3 (Asahi) and R350 (Vascular Solutions)
 Tip-in:
 Soft, intermediate – directional wires

18. New wires
 Gaia next (Asahi)
 Confianza pro 20 (Asahi) = Astato
 Judo (Boston Scientific)

19. XTRAND coil
Hollow coil made by ropes composed
by several wires woven together
1(one) / 2(Two) / 3(Three)

20. Conventional coil
Single wire coil
Hollow coil made with only 1 metal wire
Single wire
What’s XTRAND coil?

21. XTRAND coil
XTRAND coil
Hollow coil composed by ropes made by multiple wires
Rope
What’s XTRAND coil?

22. Line-up
Tip Load
Increased penetration: higher tip load
load compared with the current series.

23. Gaia micro-cone tip
Regular GuidewireBecause of GAIA’s micro-cone tip、
penetration ability is enhanced, and
penetration force becomes higher
Penetration force
Tip Load/cross section area

24. Counter
clockwise(CCW)
CLOSED COIL
Stronger torque
Clockwise(CW)
OPEN COIL
XTRAND coil

25. SENTAI™ Guidewire Family
Highly stenosed
lesions
Soft tissue
probing &
microchannel
navigation
Complex lesions
w/ visible
channels
Frontline cases
0.5 1.0 1.5 10 14
Tip Load
ClinicalApplication
3 6
Complex lesion,
intraluminal
navigation
*Not available for sale; expected clinical positioning. Coming Q4, 2018.
JUDO 1*
0.008”
FIGHTER
0.009”
HORNET
10
0.008”
HORNET
14
0.008”
SAMURAI
JUDO 3*
0.008”
JUDO 6*
0.008”
SAMURAI
RC
MARVEL
Hydrophilic, spring coil Hydrophilic, polymer jacketModerated hydrophilic, spring coil

26. Conclusions
 Wires are an essential part of CTO-PCI
 Know your wires (6 might be sufficient):
 Tiploads, penetration force, steeribility, tracking…
 Limit the number of wires you use, use simple algorythms when you start
 No wire can find the way, unless you steer it
 Inpredictibility results in being amazed (positive/negative)