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CORONARY GUIDEWIRES: TYPES AND SELECTION
- 1. CORONARY GUIDEWIRES Dr Rikesh Tamrakar MBBS, MD, DM
- 3. WAY TO GO…… • Characteristics • Construction • Types • Curves • Complications • Conclusion
- 5. GUIDE WIRE BUILDING BLOCKS
- 7. Core Material • Less flexible • More susceptible to kinking Stainless steel •Good torquability •Transmission of push force •Good support •Good shape ability •Greater tactile feedback Nitinol •Excellent flexibility and steering •Better trackability •Kink resistant •More durable •can be used for multiple vessel PCI • Less torquable • Less tactile feedback
- 8. Core Diameter • More flexibility • Enhanced trackability • Less support • More support
- 9. Core Tapers • Better steering & tracking • Decreased prolapse • Less distal support • More distal support • Better torque response • More likely to prolapse
- 10. Tip Design Shaping ribbon •Soft & flexible atraumatic tip •Better shapeability & shape memory Core-to-tip • Precise tip control • Better force transmission • Increase support • Greater tactile feedback • Decrease flexibility • Less support • Less control • More prolapse Distal tip weld- Short (≤2mm) compact cap forming true distal end to ↓ trauma
- 11. Tip Load • • • Floppy - < 1 g CTO - > 3 g
- 12. Coils Radio-opaque Tip Coils Coils • Maintains diameter • Torque control • Tactile feedback Tapered Coils
- 13. Covers • Not to be confused with Coatings • Polymer • Smooth tracking through tortuosity • Provide smoother surface for hydrophilic coating • Can be placed over coils or core without coils • Coil & cover combination can be used
- 14. Coatings • Affect lubricity & tracking • Facilitate smooth movement Types Hydrophilic ➢ Solid when dry becomes gel when wet ➢ Go anywhere without resistance ➢ Do not deteriorate during prolonged use ➢ Large Dissections ➢ False lumen ➢ Seek branches ➢ Perforation of small branch ➢ Tendency to stick to catheter ➢ Should not be jailed ➢ ➢ ➢ ➢ Hydrophobic Repels water ↓ friction to 1/2 of non- coated wire Preserves tactile feel Easy parking ability
- 15. Coatings Lubricity vs. Tactile Feedback
- 16. GUIDE WIRE SELECTION STRATEGIES
- 19. Desirable Characteristics Frontline Finesse Extra Support Specialty Workhorse • Safety • 1:1 torque • Moderate support • Excellent tip shape retention • Durable / no tip breakage • 1:1 torque • Excellent trackability through tortuosity • Single core • Moderate support • No perforation • Avoid subintimal passage • Lubricity with • Provide more support for tortuous anatomy & distal lesions • Does not spring back • Soft gentle tip • Variety of tip stiffness and/or tip tapers for excellent crossability • Tip shape retention • Moderate support • Doesn’t perforate vessel
- 20. The wires • BMW series (Abbott) • Runthrough-NS (Terumo) • Route / Rinato (Asahi Intecc) • • Zinger (Medtronic) Cougar (Medtronic) • All Track Wire / ATW (Cordis) • Galeo (Biotronik)
- 21. BMW • Gentle tip loads • Outstanding durability
- 22. BMW
- 23. Runthrough-NS • Dual-core: SS + Nitinol • Straight tip • 30 cm radio-opaque tip • Tip load: Extrafloppy- 0.6 g Floppy- 1 g
- 24. Route / Rinato More support
- 25. Zinger • Stainless-steel core • Straight / J tip • 20 cm radio-opaque tip
- 27. Desirable Characteristics Workhorse Extra Support Specialty Frontline Finesse • Safety • 1:1 torque • Moderate support • Excellent tip shape retention • Durable / no tip breakage • 1:1 torque • Excellent trackability through tortuosity • Single core • Moderate support • No perforation • Avoid subintimal passage • Lubricity with tactile feedback • Provide more support for tortuous anatomy & distal lesions • Does not spring back • Soft gentle tip • Variety of tip stiffness and/or tip tapers for excellent crossability • Tip shape retention • Moderate support • Doesn’t perforate vessel
- 28. The wires • Fielder (Asahi Intecc) • Sion / Sion blue (Asahi Intecc) • Whisper (Abbott) • Balance (Abbott) • Wizdom (Cordis) • Choice PT / PT2 / PT Graphix (Boston scientific)
- 29. Fielder series
- 30. Asahi Sion / Sion blue Composite core technology designed for outstanding torque in small vessels Twist wire • Allow smaller, more flexible core • Provide excellent tip durability Rope Coil • Excellent Torque Transmission • Wire protection for durability
- 32. Desirable Characteristics Workhorse Frontline Finesse Specialty Extra Support • Safety • 1:1 torque • Moderate support • Excellent tip shape retention • Durable / no tip breakage • 1:1 torque • Excellent trackability through tortuosity • Single core • Moderate support • No perforation • Avoid subintimal passage • Lubricity with • Provide more support for tortuous anatomy & distal lesions • Does not spring back • Soft gentle tip • Variety of tip stiffness and/or tip tapers for excellent crossability • Tip shape retention • Moderate support • Doesn’t perforate vessel
- 33. The wires Extra support • BHW (Abbott) • All star (Abbott) • Stabilizer Plus / XS (Cordis) • Zinger Support (Medtronic) • Thunder (Medtronic) Super extra support • Grand slam (Asahi Intecc) • Iron man (Abbott) • Mail man (Boston Scientific) • Platinum plus (Boston Scientific)
- 35. Desirable Characteristics Workhorse Frontline Finesse Extra Support Specialty • Safety • 1:1 torque • Moderate support • Excellent tip shape retention • Durable / no tip breakage • 1:1 torque • Excellent trackability through tortuosity • Single core • Moderate support • No perforation • Avoid subintimal passage • Lubricity with • Provide more support for tortuous anatomy & distal lesions • Does not spring back • Soft gentle tip • Variety of tip stiffness and/or tip tapers for excellent crossability • Tip shape retention • Moderate support • Doesn’t perforate vessel
- 36. Tip load vs. Support
- 37. Wires CTO Guidewires Polymer-covered (Hydrophilic) Non-covered (Hydrophilic / hydrophobic / hybrid)
- 38. Non-covered CTO wires Hydrophilic • Cross-IT (Abbott) • Persuader (Medtronic) Hydrophobic • • Miracle Bros (Asahi) Conquest / Confianza (Asahi) • Persuader (Medtronic) Hybrid • Conquest / Confianza Pro (Asahi) Flat tip • Miracle Bros (Asahi) • Persuader 3/6 (Medtronic) Tapered tip • Cross-IT (Abbott) • Persuader 9 (Medtronic) • Conquest / Confianza Pro (Asahi)
- 39. HOW TO BEND YOUR WIRE
- 40. The concept • Reaching distance (RD): ➢ Shortest distance between tip & long axis of wire ➢ Related to vessel diameter & position of guidewire in lumen • Angle (β): ➢ Angle created by long axis of wire & angled arm ➢ Approximate angulation of vessel • Length of the angled arm (L): ➢ Distance between tip & point where wire is bent ➢ Determinant of flexibility RD = sin β x L
- 43. COMPLICATIONS RELATED TO WIRES
- 44. Complications • Plaque embolisation • Dissection and perforation • Concertina effect • Acute closure due to vasospasm • Wire fracture • Wire tip entrapment
- 45. Take home • Know your tools before you play with. • One shoe does not fit all. • Right choice makes your life easy. • Be gentle, don’t be in a hurry.
- 46. THANK YOU