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Teleflex Guidewires performance in microcatheters
- 1. 1 J. Dens, Ziekenhuis oost Limburg, Belgium 17 september 2021, Firenze Microcatheter and Guidewire interaction in complex PCI MCI-2021-0435
- 2. 2 • I,Dr Dens, received speaker honorary from Teleflex for this presentation. Disclosure Statement of Financial Interest
- 3. 3 Spectrum of Complexity in PCI High Complexity PCI Procedure Lower Procedural Success
- 4. 4 Spectrum of Complexity in PCI High Complexity PCI Procedure Need for specialised devices
- 5. 5 the ABC matrix of challenges Angulation & tortuosity Back-Up & support Calcium & disease Patient Outcomes Devices
- 6. 6 Access, Support & Delivery Crossing COMBO Plaque Modification Imaging the ABC matrix Back-Up & support PCI Procedure Guidewire Micro Catheter Calcium & disease Angulation & tortuosity Guide Extension Balloon Rota/IVL etc
- 7. 7 Two components & combinations • “Rotational” • Intermediate (polymeric) • High tip load • “Sliding” • Workhorse • Low tip load, tapered Wires MicroC MicroC Wires Fielder Fighter Bandit Pilot 200 Gladius Raider Confianza Hornet 14 Warrior Finecross Caravel Nhancer Supercross … Corsair Turnpike Mamba …
- 8. 8 Key components of wires Lubricity Support, push, torque Maneuverability, flexebility, torque Lesion entrance, navigation
- 9. 9 0.014” first escalation specialty wire Stainless steel core-to-tip construction 17 cm polymer jacket 17 cm hydrophilic coating 16 cm coil 10 cm radiopaque tip 0.008” tapered tip 0.8 g tip load 200 cm and 300 cm working length Bandit Guidewire
- 10. 10 0.014” second escalation specialty guidewire Stainless steel core-to-tip construction 30 cm polymer jacket 30 cm hydrophilic coating 25 cm coil 10 cm radiopaque tip Non-tapered tip 4 g tip load 200 cm* and 300 cm working length Raider Guidewire * 190cm was a previous length that may still be in distribution in select geographies
- 11. 11 0.014” high penetration power guidewire Stainless steel core-to-tip construction 20 cm hydrophilic coating 20 cm coil 2.5 cm radiopaque tip 0.009” tapered tip 14 g tip load, consistent with the Hornet™ 14 guidewire 200 cm and 300 cm working length Excellent torque response and high penetration power 7 Warrior Guidewire 7Based on bench test data, n=10, and analyzed with 95% confidence as a percentage of means. Penetration power refers to the labeled tip load divided by the cross sectional area of the tip. Bench test results may not be indicative of clinical performance.
- 12. 12 Tip: entry profile, (hydrophylic) coating, tip lenght Braid Coils Key components of MC
- 13. 13 13 Section 4 – Understand the need and use of additional tools Single Lumen Microcatheter Tip entry profile 1.3Fr (0.42mm) Shaft O.D. Distal – 2.6Fr (0.87mm) Proximal – 2.8Fr (0.93mm) Construction SHINKA-Shaft ASAHI Corsair Pro Hydrophilic coating 60cm shaft (135cm & 150cm shaft) Cross sectional view Dual-layer, bidirectional coil: Adds kink-resistance & torque (single coil in distal 21 cm of LP shaft) Braid: For tensile strength Braid: For tensile strength Teleflex Turnpike
- 14. 14 Antegrade CorsairTM Pro Catheter Turnpike Catheter 2.6 Fr 0.87 mm2 2.6 Fr 0.87 mm Dual Coil 443% more torque than the Corsair™ Pro Catheter1 Single coil torqueable Microcatheter 1 All values based on bench test data averages, n=5, performed by Teleflex. Catheters rotated based on their respective coil orientation. Bench test results may not necessarily be indicative of clinical performance. Data on file. 2 https://asahi-inteccusa-medical.com/product/asahi-corsair-pro-microcatheter/ - accessed 04/2021.
- 15. 15 Retrograde CaravelTM Catheter Turnpike LP Catheter 2.2 Fr 0.74mm 1.9 Fr 0.62mm2 79% more torque than the Corsair™ Pro Catheter1 Non-torqueable2 1 All values based on bench test data averages, n=5, performed by Teleflex. Catheters rotated based on their respective coil orientation. Bench test results may not necessarily be indicative of clinical performance. Data on file. 2 https://asahi-inteccusa-medical.com/product/coronary-asahi-caravel/ - accessed 04/2021.
- 17. 17 1. Tip Load
- 18. 18 Tip Load Test Pipe X grams 2mm XXmm Guidewire Labelled Tip Load ‘the number on the box’
- 19. 19 Penetration Wire Medium Weight Low Weight 0.3 0.6 0.7 0.8 0.8 1 1 1.2 1.5 1.7 3 3 3 3 3.5 4.1 4.5 6 6 10 12 12 13 14 15 0 2 4 6 8 10 12 14 16 Tip Load (g) Wire Tip Load Excerpt From: “A guide to mastering Antegrade CTO PCI.” iBooks. J Spratt, S Walsh, C Wire Tip Load
- 21. 21 TIP LOAD + TAPER = PF △PF Wire Tip Load (g) Coating/Cover Tapered Tip Diameter (inches) Penetration Force (grams/mm2) Suoh 3 0.3 Hydrophilic No 0.014 3 Fielder XTR 0.6 Polymer Jacket Yes 0.01 18 SION 0.7 Hydrophilic No 0.14 7 Fielder XT 0.8 Polymer Jacket Yes 0.009 19 SION Black 0.8 Polymer/Hydrophilic No 0.014 8 Fielder XT-A 1 Polymer Jacket Yes 0.01 28 Judo 1 1 Hydrophilic Yes 0.008 31 Samurai RC 1.2 Hydrophilic No 0.014 12 Fighter 1.5 Polymer Jacket Yes 0.009 37 Gaia First 1.7 Hydrophilic Yes 0.01 34 ULTIMATEbros 3 3 Silicone No 0.014 30 ProVia 3 3 Hydrophilic with hydrophobic tip No 0.014 30 Judo 3 3 Hydrophilic Yes 0.008 93 Gladius 3 Polymer Jacket No 0.014 30 Gaia Second 3.5 Hydrophilic Yes 0.01 69 Pilot 200 4.1 Polymer Jacket No 0.014 41 Gaia Third 4.5 Hydrophilic Yes 0.012 62 Judo 6 6 Hydrophilic Yes 0.008 185 ProVia 6 6 Hydrophilic with hydrophobic tip No 0.014 60 Hornet 10 10 Hydrophilic Yes 0.008 308 MIRACLEbros 12 12 Silicone No 0.014 121 Confianza Pro 12 12 Hydrophilic Yes 0.009 292 Progress 200 13 Hydrophilic Yes 0.009 317 Hornet 14 14 Hydrophilic Yes 0.008 432 Provia 15 15 Hydrophilic with hydrophobic tip Yes 0.009 365 Excerpt From: “A guide to mastering Antegrade CTO PCI.” iBooks. J Spratt, S Walsh, C Hanratty
- 22. 22 2. Effective Tip Load (ETL)
- 23. 23 Effective Tip Load (ETL) Microcatheter X grams 2mm X mm Effect a microcatheter has on guidewire tip load Effective Tip Load is the tip load that a guidewire exhibits when used in combination with a microcatheter at a particular distance from the guidewire tip. This number highlights the effect that a microcatheter has on guidewire tip load.
- 24. 24 3. Effective Tip Load Range
- 25. 25 Effective Tip Load Range (ETL Range) 6mm Microcatheter 4mm Microcatheter 2mm Electric Balance Effective tip load range is the tip load range that a guidewire exhibits as a microcatheter is advanced from 12mm to 2mm from the distal tip of the guidewire.
- 26. 26 Effective Tip Load Range (ETL Range) 6mm Microcatheter 4mm Microcatheter 2mm Electric Balance 8mm Microcatheter 6mm Microcatheter 4mm Electric Balance 12mm 8mm Microcatheter Microcatheter 6mm Electric Balance 12mm 10mm Microcatheter 12mm Microcatheter 8mm Microcatheter Electric Balance 12mm Microcatheter Microcatheter Microcatheter Electric Balance 10mm Microcatheter Electric Balance 2mm 12mm Effective tip load range is the tip load range that a guidewire exhibits as a microcatheter is advanced from 12mm to 2mm from the distal tip of the guidewire.
- 27. 27 Turnpike Catheter 12, 10, 8, 6, 4, 2 mm COMBO: Effective Tip Load Range (gf)1,2 5gf 10gf 15gf 20gf 25gf 30gf 35gf Labelled Tip Load LOW 2gf < (Bandit Guidewire) Labelled Tip Load MED 2gf < > 5gf (Raider Guidewire) Labelled Tip Load HIGH 5gf < (Warrior Guidewire) 1All data based on bench test averages, n=5, performed by Teleflex. Bench test results may not necessarily be indicative of clinical performance. Data on file. 2Effective tip load range is the tip load range that a guidewire exhibits as a microcatheter is advanced from 12mm to 2mm from the distal tip of the guidewire.
- 28. 28 Turnpike Catheter 12, 10, 8, 6, 4, 2 mm COMBO: Effective Tip Load Range (gf)1,2 5gf 10gf 15gf 20gf 25gf 30gf 35gf Overlap Overlap 1All data based on bench test averages, n=5, performed by Teleflex. Bench test results may not necessarily be indicative of clinical performance. Data on file. 2Effective tip load range is the tip load range that a guidewire exhibits as a microcatheter is advanced from 12mm to 2mm from the distal tip of the guidewire.
- 29. 29 Turnpike Catheter 12, 10, 8, 6, 4, 2 mm COMBO: Effective Tip Load Range (gf)1,2 5gf 10gf 15gf 20gf 25gf 30gf 35gf 1 Microcatheter + 3 Guidewires 1All data based on bench test averages, n=5, performed by Teleflex. Bench test results may not necessarily be indicative of clinical performance. Data on file. 2Effective tip load range is the tip load range that a guidewire exhibits as a microcatheter is advanced from 12mm to 2mm from the distal tip of the guidewire.
- 30. 30 Warrior Guidewire Turnpike Catheter CorsairTM Pro Catheter Turnpike LP Catheter CaravelTM Catheter Crossing COMBO https://asahi-inteccusa-medical.com/product/coronary-asahi-caravel/ - accessed 04/2021. https://asahi-inteccusa-medical.com/product/asahi-corsair-pro-microcatheter/ - accessed 04/2021.
- 31. 31 gf Warrior Guidewire Turnpike Catheter CaravelTM Catheter Crossing COMBO COMBO Effective Tip Load Range 11.8g to 33.16g 0 5 10 15 20 25 30 35 2mm 4mm 6mm 8mm 10mm 12mm COMBO Effective Tip Load Range1 21.2gf to 11.8gf COMBO Effective Tip Load Range1 33.2gf to 11.8gf 1Effective tip load range is the tip load range that a guidewire exhibits as a microcatheter is advanced from 12mm to 2mm from the distal tip of the guidewire. All data based on bench test averages, n=5, performed by Teleflex. Bench test results may not necessarily be indicative of clinical performance. Data on file. https://asahi-inteccusa-medical.com/product/coronary-asahi-caravel/ - accessed 04/2021.
- 32. 32 gf Warrior Guidewire Crossing COMBO Corsair™ Pro Catheter Turnpike LP Catheter 0 5 10 15 20 25 30 35 2mm 4mm 6mm 8mm 10mm 12mm COMBO Effective Tip Load Range1 26.9gf to 12.9gf COMBO Effective Tip Load Range1 26.4gf to 12.7gf All data based on bench test averages, n=5, performed by Teleflex. Bench test results may not necessarily be indicative of clinical performance. Data on file. 1Effective tip load range is the tip load range that a guidewire exhibits as a microcatheter is advanced from 12mm to 2mm from the distal tip of the guidewire. https://asahi-inteccusa-medical.com/product/asahi-corsair-pro-microcatheter/ - accessed
- 33. 33 Understanding Microcatheter & Guidewire interaction
- 34. 34 gf Warrior Guidewire Crossing COMBO Turnpike Catheter 0 5 10 15 20 25 30 35 2mm 4mm 6mm 8mm 10mm 12mm 0 5 10 15 20 25 30 35 2mm 4mm 6mm 8mm 10mm 12mm Advancing the Turnpike Catheter increases ETL approximately 2gf per 2mm from 12mm to 6mm from the Warrior Guidewire tip1 All data based on bench test averages, n=5, performed by Teleflex. Bench test results may not necessarily be indicative of clinical performance. Data on file. 1Effective tip load range is the tip load range that a guidewire exhibits as a microcatheter is advanced from 12mm to 2mm from the distal tip of the guidewire.
- 35. 35 Warrior Guidewire Crossing COMBO Turnpike Catheter 0 5 10 15 20 25 30 35 2mm 4mm 6mm 8mm 10mm 12mm gf Distance 14.7 gf Turnpike All data based on bench test averages, n=5, performed by Teleflex. Bench test results may not necessarily be indicative of clinical performance. Data on file. Effective tip load range is the tip load range that a guidewire exhibits as a microcatheter is advanced from 12mm to 2mm from the distal tip of the guidewire.
- 36. 36 gf Warrior Guidewire Crossing COMBO Turnpike LP Catheter 0 5 10 15 20 25 30 35 2mm 4mm 6mm 8mm 10mm 12mm 0 5 10 15 20 25 30 35 2mm 4mm 6mm 8mm 10mm 12mm Advancing Turnpike LP Catheter increases ETL approximately 1.2gf per 2mm from 12mm to 6mm from the Warrior Guidewire tip1 All data based on bench test averages, n=5, performed by Teleflex. Bench test results may not necessarily be indicative of clinical performance. Data on file. 1Effective tip load range is the tip load range that a guidewire exhibits as a microcatheter is advanced from 12mm to 2mm from the distal tip of the guidewire.
- 37. 37 gf Warrior Guidewire Crossing COMBO Turnpike LP Catheter 0 5 10 15 20 25 30 35 2mm 4mm 6mm 8mm 10mm 12mm Turnpike LP 10.3gf All data based on bench test averages, n=5, performed by Teleflex. Bench test results may not necessarily be indicative of clinical performance. Data on file. Effective tip load range is the tip load range that a guidewire exhibits as a microcatheter is advanced from 12mm to 2mm from the distal tip of the guidewire.
- 39. 39 Microcatheter impact on ETL Range: Teleflex Guidewires1,2 CaravelTM Catheter Bandit Guidewire Raider Guidewire Warrior Guidewire Bandit Guidewire Bandit Guidewire Raider Guidewire Warrior Guidewire Bandit Guidewire Raider Guidewire Warrior Guidewire Warrior Guidewire Raider Guidewire Turnpike Catheter Turnpike LP Catheter CorsairTM Pro Catheter 5gf 10gf 15gf 20gf 25gf 30gf 35gf 1All data based on bench test averages, n=5, performed by Teleflex. Bench test results may not necessarily be indicative of clinical performance. Data on file. 2Effective tip load range is the tip load range that a guidewire exhibits as a microcatheter is advanced from 12mm to 2mm from the distal tip of the guidewire.
- 40. 40 Warrior, Hornet 14, Confianza Pro 12 Guidewires & Microcatheters1,2 CaravelTM Catheter Turnpike Catheter Turnpike LP Catheter CorsairTM Pro Catheter Warrior Guidewire Warrior Guidewire Warrior Guidewire Warrior Guidewire Confianza™ Pro 12 Guidewire Hornet™ 14 Guidewire Confianza™ Pro 12 Guidewire Hornet™ 14 Guidewire Confianza™ Pro 12 Guidewire Hornet™ 14 Guidewire Confianza™ Pro 12 Guidewire Hornet™ 14 Guidewire 5gf 10gf 15gf 20gf 25gf 30gf 35gf 1All data based on bench test averages, n=5, performed by Teleflex. Bench test results may not necessarily be indicative of clinical performance. Data on file. 2Effective tip load range is the tip load range that a guidewire exhibits as a microcatheter is advanced from 12mm to 2mm from the distal tip of the guidewire.
- 41. 41 Raider, Pilot 200 Guidewires & Microcatheters1,2 CaravelTM Catheter Turnpike LP Catheter CorsairTM Pro Catheter Raider Guidewire Raider Guidewire Pilot™ 200 Guidewire Raider Guidewire Pilot™ 200 Guidewire Pilot™ 200 Guidewire Raider Guidewire Pilot™ 200 Guidewire Turnpike Catheter 2gf 4gf 6gf 8gf 10gf 12gf 14gf 1All data based on bench test averages, n=5, performed by Teleflex. Bench test results may not necessarily be indicative of clinical performance. Data on file. 2Effective tip load range is the tip load range that a guidewire exhibits as a microcatheter is advanced from 12mm to 2mm from the distal tip of the guidewire.
- 42. 42 Bandit, Fielder XT Guidewires & Microcatheters1,2 CaravelTM Catheter Turnpike Catheter Turnpike LP Catheter CorsairTM Pro Catheter Bandit Guidewire Fielder™ XT Guidewire Bandit Guidewire Fielder™ XT Guidewire Bandit Guidewire Fielder™ XT Guidewire Bandit Guidewire Fielder™ XT Guidewire 1gf 1.5gf 2gf 2.5gf 3gf 3.5gf 4gf 1All data based on bench test averages, n=5, performed by Teleflex. Bench test results may not necessarily be indicative of clinical performance. Data on file. 2Effective tip load range is the tip load range that a guidewire exhibits as a microcatheter is advanced from 12mm to 2mm from the distal tip of the guidewire.
- 43. 43 Short CTO of RAC, distal cap at bifurcation
- 44. 44 Bandit, deviation into side branch (place of lower resistance)
- 45. 45 Switch to Raider: higher tipload: extra plaque track
- 46. 46 Switch to Warrior: redirection with MC far from tip
- 47. 47 Warrior following vessel – torque transmission on tip
- 48. 48 Final result
- 49. 49 CTO RAC: J-CTO 3 (blunt, long +++, calcified ++)
- 51. 51 Behaviour of Warrior: feel the cap, advance MC, let wire build up force and power transmission
- 52. 52 Result
- 53. 53 • Microcatheter choice at <10mm from the tip of the guidewire increasingly impacts the effective tip load (ETL) of a guidewire2 • The Turnpike Catheter consistently provides the widest ETL Range across all tip load groups of wires measured2 • The Turnpike LP Catheter provides no significant difference in ETL Range, across all Guidewire groups, when compared to the Corsair™ Pro Catheter, while also providing a lower crossing profile3,4 1Effective tip load range is the tip load range that a guidewire exhibits as a microcatheter is advanced from 12mm to 2mm from the distal tip of the guidewire 2 All data based on bench test averages, n=5, performed by Teleflex. Bench test results may not necessarily be indicative of clinical performance. Data on file. 3All data based on bench test averages, n=5, performed by Teleflex and analyzed with 95% confidence as a percentage of means. Bench test results may not necessarily be indicative of clinical performance. Data on file. 4https://asahi-inteccusa-medical.com/product/asahi-corsair-pro-microcatheter/ - accessed 04/2021. Key Takeaways1
- 54. 54 Advancing the Turnpike & Turnpike LP Catheters from 6 - 2mm distance from the Guidewire tip dramatically increases the ETL of the guidewire The effect of interaction decreases with softer microcatheters The interaction and absolute increase in tipload is the highest with high tipload wires Key Takeaways Thank you
- 55. 55 Thankyou Caravel, Corsair Pro are trademarks or registered trademarks of Asahi Intecc. Teleflex, the Teleflex logo, Bandit, Raider, Turnpike, Turnpike LP, Warrior are trademarks or registered trademarks of Teleflex Incorporated of Teleflex Incorporated or its affiliates, in the U.S. and/or other countries. © 2021 Teleflex Incorporated. All rights reserved. MCI-2021-0435 Rev 09/2021
Editor's Notes
- Tip loads can vary over the many offerings of wires. This is a small sample of some of the highest used specialty wires. Based on characteristics and tip loads, they can be generally categorized into three separate buckets: Low weight Medium weight Penetration These all have certain characteristics that lend them to disease states depending on what we’ve already gone over. This ranges from loose tissue tracking, knuckling, cap penetration, or intraluminal crossing/directional.
- “Tapered tip wires transmit forward push over a smaller area resulting in a higher penetration force than equivalent non-tapered wires.” Excerpt From: “A guide to mastering Antegrade CTO PCI.” iBooks.
- All figures below are in gf Turnpike Bandit Range 0.8 – 4.0 Raider Range 3.5 – 13.7 Warrior Range 11.8 – 33.2 Corsair Pro Bandit Range 0.9 – 3.6 Raider Range 3.5 – 9.7 Warrior Range 12.7 - 26.4 Turnpike LP Bandit Range 0.9 – 3.8 Raider Range 4.1 - 13.0 Warrior Range 12.9 – 26.9 Caravel Bandit Range 0.8 – 2.9 Raider Range 3.5 - 6.9 Warrior Range 11.8 – 21.2
- All figures below are in gf Turnpike Warrior Range 11.8 – 33.16 CP12 Range 10.18 – 29.78 Hornet 14 Range 9.78 – 28.42 Corsair Pro Warrior Range 12.72 – 26.4 CP12 Range 12.558 – 23.16 Hornet 14 Range 12.82 – 21.7 Turnpike LP Warrior Range 12.882 – 26.94 CP12 Range 11.25 – 22.42 Hornet 14 Range 15.72 – 24.38 Caravel Warrior Range 11.8 – 21.18 CP12 Range 11.366 – 17.214 Hornet 14 Range 12.42 – 18.74
- All figures below are in gf Turnpike Raider 3.54 – 13.716 Pilot 200 3.254 – 14.366 Corsair Pro Raider 3.532 – 9.654 Pilot 200 3.166 – 8.988 Turnpike LP Raider 4.062 – 12.97 Pilot 200 3.642 – 11.144 Caravel Raider 3.492 – 6.932 Pilot 200 3.226 – 7.528
- All figures below are in gf Turnpike Bandit 0.764 – 3.97 Fielder XT 1.06 – 3.516 Corsair Pro Bandit 0.864 – 3.604 Fielder XT 1.064 – 3.0 Turnpike LP Bandit 0.852 – 3.832 Fielder XT 1.1 – 3.18 Caravel Bandit 0.848 – 2.894 Fielder XT 1.086 – 2.79