New wires, what we have, what is essential, what is on the horizon George Sianos, Greece The Experts “Live” Workshop 2017 Friday, September 15th, 2017

1. Prof Georgios Sianos, MD, PhD, FESC
AHEPA University Hospital
Thessaloniki, Greece
Aristotle University
of Thessaloniki
A’ Cardiology Department
AHEPA University Hospital
NEW WIRES; WHAT
WE HAVE, WHAT IS
ESSENTIAL, WHAT IS
IN THE HORIZON
Session 3 Advances in CTO PCI
13:30-13.40

2. GUIDEWIRE ANATOMY
Tip styles Core tapers
& materials
Coils & covers Coatings
Core diameter

3. MILESTONES IN CTO WIRE TECHNOLOGIES
Sianos et al. BMC Cardiovascular Disorders (2016) 16:33

4. Observe the guidewire surface with electron micrograph
Coil typePolymer jacket type
POLYMER JACKET TYPE TO REDUCE THE RESISTANCE

5. POLYMER JACKET TYPE TO REDUCE THE RESISTANCE
Resistance 70%↓

6. Transitionless core design
Three levels of support for
easier device delivery
Superb trackability and torquebility
HI-TORQUE WHISPER

7. ASAHI FIELDER FC

8.  Tip load: 1.5g/ 2.7g/ 4.1g
 Radiopaque length: 3 cm
 Outside diameter: 0.014“
 Tip Outside diameter: 0.014“
 Coating: Hydrophilic
 Tip style: Core to tip
 Polymer cover: Full Polymer
 CORE MATERIAL: DURASTEEL Stainless Steel
ABBOTT HI-TORQUE PILOT 50/150/200

9. CHOICE® PT FLOPPY
• Combines a hydrophilic-coated polymer sleeve with an intermediate tip and
flexible body
• Tip Flexibility/Style: Intermediate/Polymer
• Tip Radiopacity: 35cm
• Rail Support: Light
• Core Material: Unibody stainless steel
• Coating: Hydrophilic
• Extension: Magnet Exchange Device

10. 14
ABBOTT HI-TORQUE PROGRESS ®
INTERMEDIATE
POLYMER COVER:
Hydrophilic coating for
deliverability and smooth
lesion access
CORE-TO-TIP DURASTEEL:
High tensile strength core material
and core-to-tip design for
outstanding torque response and
wire durability
TIP COILS:
Provide soft,
shapeable tip
with accurate
tactile feel
SMOOTHGLIDE:
Hydrophobic coating facilitates
device movement over the
proximal section of the wire
TURBOCOAT:
Hydrophilic coating
designed to maintain
distal wire lubricity during
long cases
TAPERED TIP:
Designed to penetrate lesions
and access micro-channels in
Chronic Occlusions

11. ASAHI MIRACLEBROS
Indroduced in 1997-Driling concept

12. ASAHI MIRACLEBROS
Indroduced in 1997-Driling concept

13. Long hydrophilic coating – high maneuverability
ULTIMATEbros3 (UB3)
Characteristics
• Long hydrophilic coating maintains high maneuverability, allowing for improved wire manipulation in
heavy stenosed lesions.
• Fine shaping improves vessel selectivity and reduces the risk of false lumen expansion.

14. Confianza
Confianza Pro
CONFIANZA ® Guidewires
Indroduced in 1998-Penetration concept

15. Confianza Pro 12
Confianza Pro 8-20
CONFIANZA ® Guidewires
Indroduced in 1998-Penetration concept

16. Polymer jacket with hydrophilic coating ;16cm
0.009”
• For collateral channel tracking
- Lower profile of tip
- Soft tapered tip = 0.009” （0.8gf）
- Small tip curve
SOFT POLYMERIC JACKET-TAPPERING FIELDER XT
Introduced in 2008-Sliding concept

17. Core Wire
Ropecoil
Coil
Twist Wire
ASAHI SION Guide Wire
Introduced in 2010-Composite core technology
Asahi Cable Tube

18. 22
WHAT IS COMPOSITE CORE TECHNOLOGY?
Multiple wire components to enhance durability and
torque transmission.

19. Prevention of Torque Whip
ASAHI SION Comp. A
*The above data was obtained by company standardized test, which may differ from industry standardized tests.
*The above data does not prove that all devices have exactly the same performance with the samples used for these tests.
Whip–A ‘jumping’ movement due to rotation accumulation

20. Structure of Fielder XT-A and Fielder XT-R
Composite Core technology
• Anti kinking structure
• Higher torque performance with W core
Tip load
XT-A = 1.0g XT-R = 0.6g
W-Coil structure
SLIP-COAT® Coating 170mm
0.36mm
(0.014”)30mm20mm
straight taper
“Composite core”
0.26mm
(0.010”) PTFE Coating
Compatible for retrograde approach ; Length 190cm
*SLIP-COAT® is a trademark of Angiotech BioCoatings Corp. in the U.S. and/or other countries.
Fielder XT-A, XT-R development concept
SOFT POLYMERIC TAPPERING JACKET GUIDE WIRES
FIELDER XT-R, FIELDER XT-A
Introduced in 2012-Fusion of Technology

21. 25
Fielder XT-A & Fielder XT-R mutual concept:
• More durability
• More controllable
Fielder XT-A focus:
Torqueability & control enhances
crossability
Fielder XT-R focus:
Flexibility & control provide
trackability
Durability & Control
Tapered type
Polymer jacket
Trackability
Tip load: 0.6gf
Crossability
Tip load: 1.0gf
Tip load: 0.8gf
SOFT POLYMERIC TAPPERING JACKET GUIDE WIRES
FIELDER XT-R, FIELDER XT-A
Introduced in 2012-Fusion of Technology

22. LIMITATIONS OF CONTEMPORARY GUIDEWIRES (GWS)
 Soft polymeric tapered GWs (Filder XT family) are excellent for
soft tissue tracking. They do have the capacity to deflect but
due to their limited penetration efficacy within the occluded
segment they have lack of directional control resulting finally
in very limited active wire control.
 Stiff spring coil GWs due to their high penetration efficacy are
excellent for hard tissue penetration but they have limited
capacity to deflect and limited directional control resulting
finally in inadequate active wire control.
 There is an unmet need in GWs technology to address the
active wire control for tracking within the CTO lesion.

23. The two mechanisms of active wire control
Deflection control by longitudinal advancement
Direction control (Torque control) by rotation
MECHANISMS OF ACTIVE WIRE CONTROL

24. Total Length 1900mm
Slip Coat Coating Length 400mm
Coil Length 150mm
0.36mm
(0.014inch) PTFE coat
First： 0.26mm (0.010inch)
Second：0.28mm (0.011inch)
Third： 0.30mm (0.012inch)
Various lineups for the different situation or lesion
Diameter ：0.26mm (0.010”) - 0.36mm (0.014”)
Tip load ：1.7gf
Diameter ：0.28mm (0.011”) - 0.36mm (0.014”)
Tip load ：3.5gf
Diameter ：0.30mm (0.012”) - 0.36mm (0.014”)
Tip load ：4.5gf
ASAHI Gaia First
ASAHI Gaia Second
ASAHI Gaia Third
Long hydrophilic coating that enhance the smooth controllability in micro catheter.
GAIA WIRES STRUCTURE
Introduced in 2013-New Concept: Deflection and Rotation

25. Gaia specification/structure
Basic structure
7mm 30mm
15mm
6mm
30mm
30mm
Straight Tapered
ASAHI Gaia First
ASAHI Gaia Second
ASAHI Gaia Third
GAIA WIRES STRUCTURE
・Double coil structure
Transfer torque to the distal with keeping flexible tip
Composite core
Composite core
Tip structure

26. ASAHI Gaia core design image
Confianza Pro core design image
ASAHI GAIA VS. CONFIANZA PRO
Difference of penetration by the thickness of the core wire

27. Lower the ball tip’s profile to provide better penetration, allowing the wire
to more easily enter hard lesions while keeping a flexible tip
Gaia micro-cone tip
G1-0.010”/G2-0.011” /G3-0.012”
GAIA WIRES STRUCTURE
Gaia microcone tip
Ball tip of general wire

28. MODIFIED PENETRATION FORCE
ASAHI Gaia micro-cone tip diameter
1.7gf
3.5gf
4.5gf
Tip diameter
12gf
5.0gf
12gf
12gf
9.0gf
kg/inch2

29. Pre shape
1mm – approx.45°
The most distal 1mm (approx.) shaped during production, saving the
operator the difficulty of manual shaping.
Possible to increase the angle to create a more acute curve manually
Possible to change re-shape the tip depending on procedural conditions
1mm
GAIA WIRES STRUCTURE
Retains shape memory during procedure

30. GAIA CONCEPT
DEFLECTION AND ROTATIONAL (DIRECTIONAL-TORQUE) CONTROL
Deflection
Rotation
Intentional control through deflection to stay true lumen

31. ASAHI GAIA THIRD？ OR CONFIANZA PRO？
Plaque=intima
Lumen
Tough tissue ・・・
Asahi Gaia ⇒ Pass by GW control ＜Deflection & Rotation＞
Confianza Pro ⇒ Pass by penetration force
Ca++
Confianza Pro
Gaia

32. Sequence of Wire Selection in Contemporary
CTO Techniques
(Antegrade and Retrograde)
Soft (<1gf)-tapered-polymeric-composite core GWs (Fielder XT-A/R) for
soft tissue tracking (passive wire control)
Intermediate stiff (2-6 gf)-tapered-composite core GWs (GAIA family) for
hard tissue tracking (active wire control)
Stiff (>9gf)-tapered GWs (Confianza pro / Progress 200T) for calcified
tissue penetration

33. SENTAI™ Guidewires
Frontline
MARVEL™ SAMURAI™
Specialty Crossing
SAMURAI™
RC
FIGHTER™ HORNET™
HORNET™
10
HORNET™
14
SENTAI™ GUIDE WIRE FAMILY

34. SAMURAI™ ICT TECHNOLOGY
Core wire
Inner Coil Coil
Samurai™ Inner Coil
Technology (ICT)
Designs goal good tip strength, tip flexibility, and reduced whipping.
• Ease of shaping
• Good shape retention
• Superior operability during a Side
Branch Approach
Core wire
Inner coil Coil

35. SAMURAI™ RC SPECIALTY CROSSING WIRE
Name
Diameter*
(inch/
mm)
Length
(cm)
Coil
(cm)
Radiopaque
(cm)
Tip Load (gf)
Core
Material
Tip
Shape
Coating
SAMURAI
RC
0.014/
0.36
190
300
24 4 1.2
Stainless
Steel
Straight
Hydrophilic
(Full Length)
Key Points
Easy-to-shape, atraumatic tip
Inner Coil Technology (ICT)
1:1 torqueability
Full coil-length hydrophilic coating
Moderate rail support
4.5gHydrophilic Coating
0.014 inch*
PTFE Coating
Radiopaque (4 cm)
Coil Length(24cm) / Hydrophilic Coating

36. Samurai™ vs. Samurai™ RC
Name
Diameter*
(inch/
mm)
Length
(cm)
Coil
Length
(cm)
Radiopaque
(cm)
Tip Load
(gf)
Core
Material
Tip
Shape
Coating
SAMURAI
0.014/
0.37
190
300
20 4 0.5
Stainless
Steel
Straight
J
Hydrophilic
(Reduced
Distal Coating)
SAMURAI RC
0.014/
0.37
190
300
24 4 1.2
Stainless
Steel
Straight
Hydrophilic
(Full Length)
4.5gHydrophilic Coating
0.014 inch*
PTFE Coating
Radiopaque (4 cm)
Coil Length(24cm) / Hydrophilic Coating
SAMURAI
RC
Reduced Hydrophilic Coating
0.014 inch*
PTFE Coating
Radiopaque (4 cm)
Coil Length (20cm) / Hydrophilic Coating
Hydrophilic Coating
10mm
SAMURAI

37. 4.5gHydrophilic Coating
0.014 inch*
PTFE Coating
Radiopaque (3.5 cm)
Coil Length(15cm) / Hydrophilic Coating
0.008inch**
Name
Diameter*
(inch/
mm)
Tip
Diameter**
(inch/mm)
Total
Length
(cm)
Coil
Length
(cm)
Radiop-
aque
(cm)
Tip Load
(gf)
Penetration
Force
(gf/mm2)
Core
Material
Tip
Shape
Coating
Hornet
0.014/
0.37
0.008/
0.20
190
300
15 3.5 1 31
Stainless
Steel
Straight Hydrophilic
Hornet 10
0.014/
0.37
0.008/
0.20
190
300
15 3.5 10 308
Stainless
Steel
Straight Hydrophilic
Hornet 14
0.014/
0.37
0.008/
0.20
190
300
15 3.5 14 432
Stainless
Steel
Straight Hydrophilic
Key Points^
Tapered tip: lowest tip profile on market (.008”)**
Hornet 14: highest tip load on market
Hornet 10 & 14: highest penetration force on market
Hydrophilic coating
Hornet™ Family
^Available competitor data Feb 2016

38. SENTAI™ Guidewires
A high-performance line of Japanese-engineered guidewires
designed to respond to the artistry of your technique.

39. ASAHI RG3

40. R350 WIRE

41. VERY COMPLEX COLLATERALS
Very challenging
collateral. What can
be the solution for
this?
RETROGRADE CTO PCI
!
53

42. SUOH 03 Construction: overview
Multiple wire components are placed inside the ASAHI SUOH 03
Twist wire
= 7 wires
Distal rope Coil
= 4 wires
ACT ONE
= 6 wires
Total 19 wires!
Core wire
= 1 wire
Proximal coil
= 1 wire

43. Distal 3 cm ‘Rope Coil’
(4 wires)
SUOH 03 Construction: rope coil
Proximal 16 cm
‘Conventional Coil’
(1 wire)
Unique distal ‘rope coil’ segment is made out of 4 wires

44. Distal 3 cm ‘Rope Coil’
(4 wires)
Rope Coil: constructed with
4 smaller-diameter wires
Results in higher flexibility
SUOH 03 Construction: rope coil
Proximal 16 cm
‘Conventional Coil’
(1 wire)
Unique distal ‘rope coil’ segment is made out of 4 wires
Only twist wire is connected to
the tip, not the core wire

45. CONCLUSION
 CTO-WG technology has done dramatic progress and is driving the
development of other technologies (micro catheters) and increasing
success rates.
 Allowed the development of various CTO techniques and dictates
different “ philosophies” among CTO operators.
 There are various GW technologies to accommodate various anatomies.
 The dogma of be familiar with “few” GW and use them optimal for
balancing success vs safety is not any more valid.
 Advanced CTO operators need to be familiar with a wide range of CTO GW
to be able to adopt all modern CTO techniques (antegrade, retrograde,
dissection re-entry) in order to reach very high success rates (>90%) while
remain safe.