Guidewires - Expert Round Table

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Abstract

Successful percutaneous coronary intervention (PCI) starts with a coronary guidewire that possesses specific characteristics designed to support advancement through various coronary vasculature anatomies. These wires can be grouped into four major categories based on their construction: stainless steel, hybrid, plastic, and niche. Steel guidewires can be further subdivided based on performance attributes: workhorse wires, which are designed to provide support, torque, and lubricity for passage through various complex anatomies, as well as to allow delivery of stents, catheters, balloons, and other devices; and chronic total occlusion (CTO) wires, which are designed for tackling the complex lesion morphology often associated with CTOs.
Today’s discussion will address the workhorse wire group. Workhorse wires account for about 70% of all coronary wires used; however, there have been precious few technological advances in workhorse wires over the past decade—arguably until now, with the development of the truly hybrid (stainless steel/nitinol) Runthrough coronary wire from Terumo. This new hybrid wire was utilized in a number of live cases at Transcatheter Cardiovascular Therapeutics (TCT) and Scripps courses in 2007, and is challenging the market domination of Abbott Vascular’s BMW and Prowater stainless steel wires. For the purpose of today’s discussion, the focus will be on the thoughts of our expert panel regarding this new hybrid wire: how it compares with what has been traditionally used in their laboratories, and whether they think it will help to increase procedural efficiency.

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Successful percutaneous coronary intervention (PCI) starts with a coronary guidewire that possesses specific characteristics designed to support advancement through various coronary vasculature anatomies. These wires can be grouped into four major categories based on their construction: stainless steel, hybrid, plastic, and niche. Steel guidewires can be further subdivided based on performance attributes: workhorse wires, which are designed to provide support, torque, and lubricity for passage through various complex anatomies, as well as to allow delivery of stents, catheters, balloons, and other devices; and chronic total occlusion (CTO) wires, which are designed for tackling the complex lesion morphology often associated with CTOs.
Today’s discussion will address the workhorse wire group. Workhorse wires account for about 70% of all coronary wires used; however, there have been precious few technological advances in workhorse wires over the past decade—arguably until now, with the development of the truly hybrid (stainless steel/nitinol) Runthrough coronary wire from Terumo. This new hybrid wire was utilized in a number of live cases at Transcatheter Cardiovascular Therapeutics (TCT) and Scripps courses in 2007, and is challenging the market domination of Abbott Vascular’s BMW and Prowater stainless steel wires. For the purpose of today’s discussion, the focus will be on the thoughts of our expert panel regarding this new hybrid wire: how it compares with what has been traditionally used in their laboratories, and whether they think it will help to increase procedural efficiency.

For background purposes, can you start by revealing how many different types of workhorse guidewire you use in general and what their various merits are?
Moses

In terms of workhorse wires I really use just two: the BMW and the Runthrough. BMW has been a stalwart over the years. It is very versatile but it has its limitations: given the standards of steerability now, it is not quite up to, say, the Runthrough or the Asahi family of wires. It is not as steerable as the most contemporary wires. It also had a stickiness problem, but that seems to be a little better with the new coating, although the transition is less than ideal. The Runthrough is a bit more steerable and also appears to be just a little more slippery going through tight lesions.

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