Everything You Need To Know To Find The Best Hydrophilic guide wire

Cerenovus Agility 10 Steerable Guidewire Stainless steel with hydrophilic coating 0.010 195 Shapeable tip The soft tips enable easy shapeability and safe vessel access; available in standard and soft configurations Cerenovus Agility 14 Steerable Guidewire Stainless steel with hydrophilic coating 0.014 205, 350 Shapeable tip The soft tips enable easy shapeability and safe vessel access; available in standard and soft configurations Cerenovus Agility 16 Steerable Guidewire Stainless steel with hydrophilic coating 0.016 175, 205 Shapeable tip The soft tips enable easy shapeability and safe vessel access; available in standard and soft configurations Nipro AquaLiner II Hydrophilic Super-Elastic Nitinol Guidewire Nitinol 0.035, 0.038 150, 180, 260 Angled, straight Engineered to provide optimal pushability, trackability, and kink resistance in challenging anatomy; offers lasting lubricity and tactile feel; our proprietary manufacturing process for the nitinol core results in a kink-resistant guidewire with torque performance that minimizes whip Cordis Aquatrack Hydrophilic Nitinol Guidewire Nitinol 0.035 150, 180, 260 Straight, angled – Asahi Intecc USA, Inc. Asahi Chikai Stainless steel with hydrophilic coating 0.014 200, 300 Straight Designed as workhorse guidewire for neurointerventional procedures; Actone, dual-coil, provides exceptional torque response and durable tip-shape retention; designed with optimum balance between tip flexibility and microcatheter support Asahi Intecc USA, Inc. Asahi Chikai 10 Stainless steel with hydrophilic coating 0.010 200, 300 Straight Designed as workhorse guidewire for neurointerventional procedures; Actone, dual-coil, provides exceptional torque response and durable tip-shape retention; designed with optimum balance between tip flexibility and microcatheter support Asahi Intecc USA, Inc. Asahi Chikai black Stainless steel Actone structure 0.014 200 Round curve/90° angle Neurointervention Asahi Intecc USA, Inc. Asahi Chikai black 18 Stainless steel Actone structure 0.016, 0.018 (reverse taper) 200 Round curve Neurointervention Asahi Intecc USA, Inc. Asahi Chikai V Stainless steel with hydrophilic coating 0.014 165 Straight Designed for super selective embolization; Actone, dual-coil, provides exceptional torque response and durable tip-shape retention for distal branch and multiple vessel embolization Asahi Intecc USA, Inc. Asahi Gaia PV Stainless steel with hydrophilic coating 0.018 200, 300 7.5-gf tip load, preshaped A tapered guidewire with micro cone tip and ACT ONE technology for effective navigation, ease of advancement, and good penetration Asahi Intecc USA, Inc. Asahi Gladius 0.014 Stainless steel with polymer jacket and hydrophilic coating 0.014 200, 300 3-gf tip load, straight A workhorse polymer-jacketed guidewire with ACT ONE technology for superior maneuverability and durability in a broad range of cases Asahi Intecc USA, Inc. Asahi Gladius 0.018 Stainless steel with hydrophilic coating 0.018 200, 300 4-gf tip load, straight A workhorse polymer-jacketed guidewire with ACT ONE technology for superior maneuverability and durability in a broad range of cases Asahi Intecc Co Ltd. Asahi Gladius Mongo 18 PV ES Stainless steel with a polymer jacket and hydrophilic coating 0.018 190, 300 3-gf tip load, straight, preshape A workhorse polymer-jacketed guidewire with high steerability, good support, and the ability to form a narrow loop for crossing and treating stenosed lesions Asahi Intecc Co Ltd. Asahi Gladius Mongo ES Stainless steel with polymer jacket and hydrophilic coating 0.014 190, 300 3-gf tip load, straight, preshape A workhorse polymer-jacketed guidewire with high steerability, good support, and the ability to form a narrow loop for crossing and treating stenosed lesions Asahi Intecc USA, Inc. Asahi Halberd 0.014 Stainless steel with hydrophilic coating 0.014 200, 300 12-gf tip load, straight A specialty guidewire with ACT ONE technology for superior directional control and effective lesion engagement Asahi Intecc USA, Inc. Asahi Halberd 0.018 Stainless steel with hydrophilic coating 0.018 200, 300 12-gf tip load, straight A specialty guide wire with ACT ONE technology for superior directional control and effective lesion engagement Asahi Intecc USA, Inc. Asahi Meister 16 Stainless steel Actone structure 0.016 165, 180 45° angle/round curve/double angle Interventional radiology procedure Asahi Intecc USA, Inc. Asahi Regalia XS 1.0 Stainless steel with a polymer jacket and hydrophilic coating 0.014 180, 300 1-gf tip load, straight A soft polymer guidewire with flexible shaft for trackability in tight lesions and difficult anatomy Asahi Intecc USA, Inc. Astato 30 Stainless steel with hydrophilic coating 0.018 180, 300 30-gf tip load, straight A specialty guidewire with tapered tip for crossing complex lesions with heavy calcification and/or tough fibrous tissue Asahi Intecc USA, Inc. Astato XS 20 Stainless steel with a tapered tip and hydrophilic coating 0.014 180, 300 20-gf tip load, straight A specialty guidewire with tapered tip for crossing complex lesions with heavy calcification and/or tough fibrous tissue Asahi Intecc USA, Inc. Astato XS 40 Stainless steel with tapered tip and hydrophilic coating 0.014 200, 300 40-gf tip load, straight A specialty guidewire with tapered tip and high tip load for crossing complex lesions with heavy calcification and/or tough fibrous tissue Medtronic Avigo .014” Hydrophilic Guidewire Stainless steel 0.014 205 Shapeable tip – Guerbet LLC Axessio Stainless steel with hydrophilic coating 0.018 180 Straight shapeable PTFE and hydrophilic coating with platinum coil tip Guerbet LLC Axessio Stainless steel with hydrophilic coating 0.014 180 Straight shapeable PTFE and hydrophilic coating with platinum coil tip Medcomp Coated Mandrel Guidewires Straight 0.010 60, 80 Platinum coil tip Hydrophilic coating Asahi Intecc Co Ltd. CrossLead 0.035 Nitinol with a polymer jacket and hydrophilic coating 0.035 200, 300 Angled A multipurpose nitinol guide wire with shapeable tip and narrow looping technology for sheath delivery, lesion crossing and device delivery in difficult anatomy and complex lesions Silk Road Medical Enroute 0.014-inch Guidewire Stainless steel with hydrophilic coating 0.014 95 Shapeable, 5-cm radiopaque tip Designed for navigating tortuous short vessel segments with its unique combination of short length, short taper, and a shapeable tip; excellent torque control and device deliverability Boston Scientific Corporation Fathom-14 Guidewire Hybrid stainless steel and nitinol 0.014 200, 300 10 cm with 2-cm shapeable or angled tip Utilizes a unique slotted nitinol hypotube design to balance exceptional torquability with tip softness and proximal support Boston Scientific Corporation Fathom-16 Guidewire Hybrid stainless steel and nitinol 0.016 140, 180, 200, 215 10, 20 cm with 2-cm shapeable or angled tip Utilizes a unique slotted nitinol hypotube design to balance exceptional torquability with tip softness and proximal support Terumo Interventional Systems Glidewire Advantage Hydrophilic Coated Guidewire Nitinol core 0.035 180, 260 Angled: 45°; tip flexibility: 5 cm 25-cm Glidewire hydrophilic distal portion for navigation; stiffer nitinol proximal portion to support device delivery with spiral PTFE coating Terumo Interventional Systems Glidewire Advantage Hydrophilic Coated Guidewire Nitinol core 0.014, 0.018 180, 300 Angled: 45°; tip flexibility: 1 cm 25-cm Glidewire hydrophilic distal portion for navigation; stiffer nitinol proximal portion to support device delivery with spiral PTFE coating; 2-cm gold coil tip Terumo Interventional Systems Glidewire Advantage Track Peripheral Guidewire Stainless steel proximal shaft; nitinol distal tip 0.014, 0.018 180, 300 Angled: 35°, flexibility: 1 cm 25-cm Glidewire hydrophilic distal portion for navigation; stiff stainless steel proximal portion to support device delivery with spiral PTFE coating; 2-cm gold coil tip Terumo Interventional Systems Glidewire Gold Hydrophilic Coated Guidewire Nitinol 0.018 180, 300 45° angle, 70° angle; tip flexibility: 3 cm Terumo Glide technology with 1-mm gold band at tip for enhanced radiopacity Terumo Interventional Systems Glidewire GT Hydrophilic Coated Guidewire Nitinol 0.016, 0.018 180, 200 45° angle, 90° angle, 90°/60° double angle, straight (shapeable); tip flexibility: 25 cm Terumo Glide technology hydrophilic coating with 2-cm gold coil at tip for enhanced radiopacity; flexible distal tip designed for superselectivity Terumo Interventional Systems Glidewire Hydrophilic Coated Guidewire Nitinol 0.018, 0.025, 0.032, 0.035, 0.038 80, 120, 150, 180, 260, 350, 400, 450 Angled, straight, 3 mm J, 1.5 mm “Baby-J”, tip flexibility: 1, 3, 5, 8 cm Terumo Glide technology hydrophilic coating with super elastic nitinol core and polyurethane jacket; standard or stiff shaft Terumo Neuro Headliner Guidewire Guidewire with Terumo Glide technology hydrophilic coating 0.012, 0.016 200 45°, 90° angle; 90°/150° double angle; 1.5-mm J-tip angle; tip flexibility: 20, 35 cm Proprietary Glidewire technology with gold coil at tip for enhanced radiopacity; distal tip specifically engineered for delicate neuro procedures; floppy and standard tip taper available Abbott Hi-Torque Command Nitinol 0.014 190, 300 Shapeable tip Designed for lower limb procedures, available in standard and extra support configurations Abbott Hi-Torque Command 18 Nitinol 0.018 190, 300 Shapeable tip Designed for lower limb procedures; available as ST (short taper, 10 cm nitinol) and LT (long taper, 25 cm nitinol) Balt Hybrid Guidewire Nitinol and stainless steel 0.012 310 Straight, shapeable Designed for stable exchange Balt Hybrid Guidewire Nitinol and stainless steel 0.008 220 Preshaped, double angle Designed for durability and flexibility Balt Hybrid Guidewire Nitinol and stainless steel 0.010 310 Straight, shapeable Designed for stable exchange Balt Hybrid Guidewire Nitinol and stainless steel 0.014 200 Straight, shapeable Designed for durability and flexibility Balt Hybrid Guidewire Nitinol and stainless steel 0.012 200 Straight, shapeable Designed for durability and flexibility Balt Hybrid Guidewire Nitinol and stainless steel 0.012 200 Preshaped, double angle Designed for durability and flexibility Balt Hybrid Guidewire Nitinol and stainless steel 0.007 220 Straight Designed for durability and flexibility Balt Hybrid Guidewire Nitinol and Stainless Steel 0.007 220 Preshaped, double angle Designed for durability and flexibility Balt Hybrid Guidewire Nitinol and stainless steel 0.008 220 Straight, shapeable Designed for durability and flexibility Abbott HydroSteer Nitinol 0.018 150, 180 Angled, straight Hydrophilic coating Abbott HydroSteer Nitinol 0.035, 0.038 150, 180, 260 Angled, straight, J-tip Hydrophilic coating Abbott HydroSteer Guide Wire Nitinol 0.035 150, 180, 260 Straight, angled Nitinol core with polymer jacket Medtronic Mirage .008” Hydrophilic Guidewire Stainless steel 0.012 > 0.008 200 Shapeable tip – Mivi Neuroscience, Inc. Mivi Vi-Radius 014 Stainless steel, hydrophilic coating 0.014 205 Radiopaque platinum tip Platinum tip allows for customized shapeability and deflection through tortuous anatomy Cerenovus Neuroscout 14 Steerable Guidewire Stainless steel with hydrophilic coating 0.014 205, 300 Shapeable tip Specifically designed for excellent tip shaping and shape retention Teleflex PiggyBack Wire Converter Polymer catheter wire converter 0.035 OD 145 Radiopaque marker embedded in distal tip Wire converter with sliding lock securely fastens onto any standard 0.014-inch wire and converts it to a 0.035-inch wire platform BD Interventional Porter Stainless steel 0.014 195, 300 Straight, 3-, 6-, 9-, 12-gauge tip stiffness Hydrophilic guidewire in various levels of tip stiffness, providing excellent trackability, steerability, visibility, and support for delivery of therapeutic devices Cook Medical Roadrunner PC Nitinol core with platinum coils, polyurethane jacket 0.035, 0.038 80, 145, 180, 260 Straight, angled Available in either a standard or stiff shaft configuration and a standard or long-taper configuration Terumo Interventional Systems Runthrough NS Extra Floppy Stainless steel proximal shaft; nitinol distal tip 0.014 180 (can be extended), 300 Floppy Hybrid wire that fuses nitinol and stainless steel for exceptional torque control and tip durability Terumo Interventional Systems Runthrough NS Hypercoat Stainless steel proximal shaft; nitinol distal tip 0.014 180 (can be extended), 300 Straight (shapeable) nitinol Enhanced hydrophilic guidewire for tortuous, distal, tight stenotic complex lesions Terumo Interventional Systems Runthrough NS Izanai Stainless steel proximal shaft; nitinol distal tip 0.014 180 (can be extended), 300 Straight (shapeable) nitinol Enhanced hydrophilic guidewire for complex, tortuous, distal, tight stenotic lesions Boston Scientific Corporation Savion DLVR Stainless steel core, polymer sleeve 0.014 182, 300 Straight (shapeable), angled (shapeable) Guidewire features a 3-cm radiopaque spring coil at the distal end of the core wire that is shapeable; a polymer sleeve, coated with ICE hydrophilic coating, jackets the tapered core wire between the spring coil and the proximal fluorinated polymer coating Boston Scientific Corporation Savion FLX Nitinol core, polymer sleeve 0.014 185, 300 Straight (shapeable), angled (shapeable) Guidewire features a 30-cm radiopaque polymer sleeve, coated with ICE hydrophilic coating, jacketing the nitinol distal core wire; the distal 2 cm is shapeable; the proximal section of the guidewire is PTFE coated Abbott Shepherd Peripheral Guidewires, 12 and 30 gram Stainless steel, hydrophilic with spring coil tip 0.014, 0.018 300 Straight, shapeable – Abbott Shepherd Peripheral Guidewires, 4 and 6 gram Stainless steel, polymer jacket with hydrophilic coating 0.014, 0.018 300 Straight, shapeable – Medtronic Silverspeed .010 Hydrophilic Guidewire Stainless steel 0.010 200 Shapeable tip – Medtronic Silverspeed .014 Hydrophilic Guidewire Stainless steel 0.014 175, 200 Shapeable tip – Merit Medical Systems, Inc. Splash Hydrophilic Coated Guide Wire Nitinol fixed core 0.018, 0.025, 0.035, 0.038 80, 150, 180, 220, 260 Straight, angled, and straight long taper; tip flexibility 5 cm; available in standard and stiff configurations Proprietary nitinol-core wire provides excellent 1:1 torque control; enhanced coating technology provides enduring lubricity for rapid vessel selection Pediavascular Spring Wire Stainless steel 0.030 140 J curve, straight 2-cm floppy tip Stryker Synchro 10 Nitinol 0.010 200, 300 Shapeable Microfabricated nitinol distal hypotube designed for efficient torque transfer Stryker Synchro 14 35-cm Nitinol 0.014 200, 300 Shapeable Microfabricated nitinol distal hypotube designed for efficient torque transfer with a 35-cm distal segment Stryker Synchro 14 45-cm Nitinol 0.014 200, 300 Shapeable Microfabricated nitinol distal hypotube designed for efficient torque transfer with a 45-cm distal segment Stryker Synchro Select Soft Nitinol 0.014 215, 300 Shapeable, preshaped Identical to Synchro Select Standard but with a softer tip and support profile Stryker Synchro Select Standard Nitinol 0.014 215, 300 Shaped, preshaped The trusted Synchro torque, reliability and stability with easier distal navigation and tip shape retention Stryker Synchro Select Support Nitinol 0.014 215, 300 Shaped, preshaped Identical to Synchro Select Standard with a more supportive profile Stryker Synchro2 Soft Nitinol 0.014 200, 300 Shapeable, preshaped Identical to Synchro2 Standard but with a softer tip and support profile Stryker Synchro2 Standard Nitinol 0.014 200, 300 Shapeable, preshaped Designed for torque control; intended for reliable stability and flexibility Stryker Synchro2 Support Nitinol 0.014 215, 300 Shapeable, preshaped Identical to Synchro2 Standard with a more supportive profile Stryker Transend 14 EX Stainless steel 0.014 182 Shapeable Scitanium alloy core wire construction enhances torque transmission and distal support Stryker Transend 300 Extra Support Stainless steel 0.014 300 Shapeable 300-cm exchange guidewire designed for proximal support with a soft platinum coil tip for superb radiopacity and atraumatic tip Stryker Transend 300 Floppy Stainless steel 0.014 300 Shapeable An exchange wire identical to the Transend 300 ES but with a floppier distal segment Boston Scientific Corporation Transend-14 Steerable Guidewire Hydrophilic coating with scitanium core 0.014 135, 165, 190 2-cm shapeable tip Product features hydrophilic coating and good torque response Boston Scientific Corporation Transend-18 Steerable Guidewire Hydrophilic coating with scitanium core 0.018 135, 165 2-cm shapeable tip Product features hydrophilic coating and good torque response Terumo Neuro Traxcess 7 Mini Hydrophilic guidewire 0.007 210 Soft 0.007-inch tip tapers to 0.014-inch guidewire body Terumo Neuro Traxcess Docking Wire Docking wire 0.014 115 – Compatible with Traxcess guidewire Terumo Neuro Traxcess Guidewire Hybrid nitinol/stainless steel construction with hydrophilic coating 0.012; 0.014 (proximal) 200 Soft, atraumatic tip; shapeable 1.4-cm tip length; straight with 0.012-inch distal diameter to access small vessels – Asahi Intecc USA, Inc. Treasure 12 Stainless steel with hydrophilic coating 0.018 180, 300 12-gf tip load, straight A specialty guidewire for controlled drilling when targeting highly stenosed, calcified lesions Asahi Intecc USA, Inc. Treasure Floppy 0.018 Stainless steel with hydrophilic coating 0.018 190, 300 4-gf tip load, straight Workhorse guidewire for nontotally occluded lesions Merit Medical Systems, Inc. True Form Reshapable Guide Wire Stainless steel 0.014 145, 165, 180 Straight, angled Reshapable tip Cook Medical Uniglide Nitinol core, polyurethane jacket 0.018, 0.035 80, 150, 180, 260, 320 Straight, angled Available in either a standard or stiff shaft configuration Boston Scientific Corporation V-14 ControlWire Guidewire Scitanium stainless steel core, polymer sleeve 0.014 182, 300 Straight, angled (shapeable) Distal radiopaque section (distal 2 cm); single-piece core with torque jacket for 1:1 torque control; shapeable tip intended to facilitate accurate placement; proximal PTFE jacket intended to provide firm support and low friction surface Boston Scientific Corporation V-18 ControlWire Steerable Guidewire Scitanium stainless steel core, polymer sleeve 0.018 110, 150, 200, 300 Straight (shapeable) Hydrophilic performance and torque control designed for distal, peripheral access and contralateral approaches; single-piece core with torque jacket for 1:1 torque control; robust shapeable 3-cm tip intended to facilitate accurate placement; proximal PTFE jacket intended to provide firm support and low friction surface US Endovascular Victoria Super elastic nitinol 0.035 145, 180, 260 Straight/angled Super elastic nitinol core/proprietary hydrophilic coating Boston Scientific Corporation Victory Guidewire Stainless steel core, polymer sleeve 0.014, 0.018 195, 300 Straight (shapeable) 12-g, 18-g, 25-g, and 30-g tip loads designed to cross highly resistant lesions; torque control designed for distal, peripheral access Medtronic X-Celerator Hydrophilic Exchange Guidewire Stainless steel 0.010, 0.014 300, 350 Shapeable tip – Medtronic X-Pedion .010 Hydrophilic Guidewires Stainless steel 0.012 > 0.010 200 Shapeable tip – Medtronic X-Pedion .014 Hydrophilic Guidewires Stainless steel 0.014 200 Shapeable tip –

2.1 Length

The selection of a guidewire with a correct length can be very relevant to adequately reach and treat the target vessel. For this decision, distance from the access to the vessel to be treated and the shaft length of the sheaths and catheters to be used (either if it is a diagnostic catheter, a balloon catheter, or a delivery device of a stent or a stent graft) needs to be considered. In fact, this apparently less relevant subject may threaten the entire procedure.

Check now

Depending on the manufacturer, guidewires can range from 80 to 450 cm. Additionally, some guidewires may allow the connection of an extension during the procedure. This is particularly the case when a coronary guidewire is used as it is designed for rapid exchange devices.

There is a trick that can help in extreme circumstances and as bailout option only. During the removal of a catheter from inside the patient, it is possible to connect an inflation syringe device to the guidewire port of the catheter, just after losing the guidewire, and inflate inside the port, which will keep the guidewire in place. It is crucial to perform this maneuver under fluoroscopy as the guidewire may move forward and the external tip can even migrate and be lost inside the patient.

2.3 Stiffness

There is no clearly accepted nomenclature that can reproductively relate a word or a group of words to the stiffness of a guidewire. As so, it is possible to find several guidewires with the label stiff, extra stiff, super stiff, or even ultra-stiff, without any objective information of its real stiffness. Flexural modulus is an engineering parameter related to a wire’s resistance to bending (Figure 2). This measure is rarely displayed on the guidewire packaging or within the catalog [1]. Yet, it represents an objective method to quantify the stiffness of a guidewire.

This property is more frequently used to describe the body of the guidewire, but its use in the description of the tip of the guidewire can be very useful too. The stiffer the body of a guidewire is, the more support it will allow to deliver the intended endovascular devices to the target vessel. On the other end, a higher stiffness of the body reduces the ability of the guidewire to track the vessel tree. Concerning the tip, a higher stiffness increases the penetration capacity, but also turns the tip more aggressive to vessel wall increasing the risk of dissection or perforation.

3.4 Coating

Most of contemporary guidewires have a thin hydrophilic or hydrophobic coating applied at the final manufacturing process (Figure 4). Hydrophilic coating (e.g., polyethylene oxide or polyvinyl pyrolidone) needs water to be activated and to become slippery, but once wet, it allows an extremely low coefficient of friction [4]. As a result, it makes vessels easier to track and stenoses simpler to cross but leads to a decreased tactile feel, increasing the risk of dissection or perforation. Paradoxically, if a guidewire with hydrophilic coating gets dry, it loses lubricity and can get stuck, for instance, inside a catheter. Conversely, hydrophobic coatings (e.g., polytetrafluoroethylene or silicones) do not require water for activation [4]. As their name indicates, they repel water and create a smooth, “wax-like” surface [3]. Hydrophobic coating reduces friction but leads to a less slippery guidewire with enhanced tactile feel. Frequently, hydrophobic coatings are applied to guidewire bodies to facilitate movement inside plastic catheters [4]. Nevertheless, both coatings can coexist in a single guidewire, allowing their respective specific characteristics to be present either at the tip or throughout the body. In some configurations, even the tip can have both coatings, for instance, hydrophobic at the end for tactile feel and tip control purposes and hydrophilic intermediate segment for smooth crossing. Moreover, both hydrophilic and hydrophobic coatings may chafe or degrade with use [4]. This can account for the deterioration in wire performance at times noted during long procedures, particularly when wires are working through areas of severe tortuosity and friction or after numerous device exchanges [4]. This can even lead the guidewire to get fixed inside the catheter, forcing both devices to be removed as one piece, jeopardizing the therapy of the targeted vessel.

4.4 Shape, shapeability, and shape retention

Most of the 0.035″ guidewires used in peripheral interventions come in a preshaped format from the manufacturer. The more common available shapes are straight, angled, and J-shaped. The latter is the least traumatic. As so, it can be the best guidewire to use to deliver the intended devices to a target vessel. It can also be quite useful in tracking throughout a previously placed patent stent because the tip will not get stuck in the struts of the stent, neither will go between the stent and the vessel wall. Straight tips are more adequate to cross occlusions and angled tips to track vessels and to cross stenoses.

On the other hand, the vast majority of the 0.014″ and 0.018″ guidewires available for peripheral purposes comes in a straight shape and needs to be shaped. As so, shapeability characterizes the capacity of the guidewire tip to be angulated and shaped by the interventionist and shape retention represents its ability to maintain the intended shape over time [3]. These properties depend on the tip design and materials. Accordingly, a core-to-tip design with a core made of stainless steel is particularly easy and accurate to be shaped, but almost impossible to be reshaped. Conversely, nitinol core makes the tip more difficult to be shaped because it tends to return to its original form (memory) but is more reshapeable.

The tip of the GW can be shaped using the puncture needle (for moderately angulated curves), with the non-cutting edge of the blade (for sharp angulations) or with the inserter (for both) (Videos 1 and 2, https://bit.ly/3jPF7aj).

The desired shape depends on the primary purpose the guidewire will be used (Figure 10). Moderately angled continuous curves are very useful to track throughout the artery tree or to select a target vessel (Figure 10A). Several sharp angulations may help in selecting arteries with an acute takeoff such as the anterior tibial artery (Figure 10B). A very short sharply angled curve (usually no more than 1 mm) is intended to perform forceful and well-controllable drilling (Figure 10C).

5.1 Basic rules for guidewire manipulation

One of the best friends of a vascular interventionist is the torquer (Figure 11). It is the most proper manner to control the orientation of the guidewire tip. Therefore, its utilization is of utmost relevance in tracking difficult anatomies or in crossing challenging lesions (for instance, if the drilling technique is to be employed).

After having crossed the target lesion, the guidewire should be advanced very smoothly to the distal segment of the vessel. Confirmation through contrast injection that the true lumen has been reached after crossing the lesion is a basic but essential step. If a guidewire with a very aggressive tip was used to cross the lesion, it should be replaced by a much safer guidewire with good body stiffness for support (frequently the initial workhorse guidewire is adequate for this intent), sometimes after having shaped the tip as a loop (J-shaped like). During the delivery of the intended devices to the target lesion, it is of paramount importance to avoid inadvertent retraction of the guidewire, particularly after a complex crossing step and to prevent back and forth or shaking motion of the guidewire. That is why the tip of the guidewire should be on sight at almost all times. In summary, the two goals are: to secure the access to the target vessel and lesion; to avoid any trauma to the distal intact vessels.

5.2 Crossing the target lesion

The opening “workhorse” guidewire can be used in an initial attempt to cross the target lesion. Nevertheless, in many circumstances, a more dedicated guidewire will be required.

You will get efficient and thoughtful service from Hainwise.

5.2.1 Crossing a stenosis

To cross a stenosis, it is perceptibly fundamental to stay intraluminal. For that purpose, the guidewire does not need to have increased stiffness, pushability, or penetration capacity. The tip should probably be hydrophilic as tactile feel is less relevant in those situations, and this can also improve the crossability of the guidewire. The tip is typically shaped in soft curve (Figure 10A), to be directed to the opposite direction of the stenosis. Specifically in tibial vessels, a 0.014″ guidewire can be preferable as in the case showed in Figure 1.

5.2.2 Crossing a chronic total occlusion

A chronic total occlusion is generally defined as an occluded artery of 3 months duration or longer [5]. When the vascular interventionist faces a chronic total occlusion, the best guidewire is obviously the one that successfully crosses the lesion. Nevertheless, there are several issues to consider in an attempt to cross a chronic total occlusion:

• The target artery. In fact, some arteries can be quite challenging to recanalize. For instance, an occlusion of the anterior tibial artery from its origin is, most of the times, very challenging to cross anterogradely because of the difficulty to engage the ostium. In those circumstances, adjuvant retrograde approach can be very helpful.

• The length of the occlusion. Longer occlusions are more difficult to cross and involve additional struggle to keep the guidewire in an intraluminal track. Moreover, the guidewire should have a stiffer body to support the crossing of a balloon or a support catheter, and it can also frequently require segmental pre-dilatations.

• The associated calcification. Depending on its length, location (entry point of the occlusion and/or in its core), and whether it is concentric or eccentric, calcification can greatly complicate the crossing of an occlusion or the reentry after a subintimal path. It also increases the risk of complications such as perforations or ateroembolization. On another hand, medial calcification can occasionally help in defining the limits of the vessel and consequently can guide the interventionist to stay intraluminal.

• Visible run-off. As a rule, the end of the chronic total occlusion should be clearly defined. Nevertheless, in some instances, such as in tibial vessels with very poor collateralization, it may not be initially adequately outlined and only appears after having crossed the occlusion.

5.2.3 Sliding technique

This technique is particularly indicated for engaging softer chronic total occlusions with microchannels [6]. It is frequently the first approach. For that intent, the initial “workhorse” guidewire with a soft hydrophilic tip and a body with some stiffness can be the option as reduced surface friction enhances passage through the chronic total occlusion core. The tip should initially be shaped in a single, long shallow bend (Figure 10A), and movement consists of simultaneous smooth tip rotation and gentle probing. But during the crossing, the interventionist should stay vigilant, as the guidewire has reduced tactile feel and typically advances with minimal resistance, frequently resulting in inadvertent entry to the subintimal space [7].

5.2.4 Drilling technique

If the sliding technique fails after a few attempts (one should not insist on this technique as it is easy to create several subintimal tracks that will jeopardize a desirable intra-luminal crossing), then the drilling technique should be tried. In this technique, a guidewire with a core-to-tip design with an uncovered tip should be preferred to enhance tactile feel. The tip is bended in a very short extension (Figure 10C) and clockwise and counterclockwise rotations of the guidewire are performed while the tip is pushed modestly against the chronic total occlusion (Figure 12). The important issue in this technique is that one does not push the guidewire very hard. Placing the balloon or the support catheter very close to the tip increases the penetration capacity. If the tip of the guidewire does not advance any more with gentle pushing, it is by far better to exchange for a stiffer tip and body guidewire, rather than continue pushing. If one pushes the wire hard, it will easily go into the subintimal space. Yet, when a stiffer guidewire is used, it may be difficult to perceive whether the tip has been engaged in the true or in a false lumen inside the chronic total occlusion. The movement of the tip may help in distinguishing one from the other. Typically, when the guidewire is in the subadventitial space, the tip budges markedly. Tactile feel from the guidewire during pullback can also aid as true lumen usually offers higher resistance. This technique has an increased risk of perforation, especially when using stiff tips guidewires [7].

5.2.5 Penetrating technique

The penetration technique comes next if the drilling technique does not succeed or when the interventionist has a chronic total occlusion with very calcified cap. In this technique, the preferred guidewires have a very aggressive tip (core to-tip design, uncovered tapered tip, with increased tip load, and a subsequent high penetration capacity) and a relatively stiff body. The tip shape is essentially straight, and a less rotational tip motion and a more direct forward probing is used in comparison to the drilling technique (Figure 13). Again, placing the balloon or the support catheter very close to the tip increases the penetration capacity and reduces the propensity of the tip to bend. Additionally, the distal target must be clearly identified and careful monitoring of the progressive guidewire advancement should be done. The guidewires employed in this technique should not be used to deliver the intended devices to the target lesion as the tip can easily damage the distally intact vessels. It is a technique with a particularly augmented risk of complications [7].

5.2.6 Subintimal technique

It is usually the last technique to be employed, even if it can be a first option in specific situations such as very long chronic total occlusions. For this technique, a guidewire with a stiff body and a soft short tip with hydrophilic coating is usually preferable. The short tip allows a short loop. After having created the loop, the guidewire is advanced to the end of the occlusion. To reenter into the true lumen, the loop has to be undone. Sometimes, the guidewire needed to be exchanged to a guidewire with a reduced diameter (if the initial guidewire was not a 0.014″ guidewire), with an uncovered tip (to increase the tactile feel and reduce the tendency to stay in the subintimal space that a hydrophilic tips has), a good torqueability, and an angled shaped tip (to be able to direct this one to the true lumen). Sometimes moving the balloon or the support catheter and the guidewire as one can be very useful (Video 3, https://bit.ly/3jPF7aj and Figure 14). If the loop, during the crossing, becomes too large, it means that most certainly, a perforation has occurred. In these situations, the guidewire should be retracted and an another subintimal track should be pursued.

5.2.7 Retrograde access

When the antegrade approach is not successful, a retrograde puncture may be required. Retrograde puncture of the popliteal artery is usually not a big issue. However, at below-the-knee level, since arteries are quite small and fragile and frequently the tibial or peroneal artery to be punctured is the unique artery to the foot, extreme care must be the rule. As so, after having performed the puncture with a 21G needle (either guided by ultrasound or by X-ray), a guidewire is to be engaged inside the artery. To avoid additional injury to the artery, the devices introduced in it should be kept at the strict minimum. That why usually it is most preferable to initially advance only the guidewire without any catheter or sheath (Figure 15). Therefore, the guidewire to be chosen needs to have a hydrophilic stiff body due to the lack of a sheath, the relevance of having adequate torqueability to guide the tip and to perform the snaring of the guidewire, and a potential need for an additional catheter if the guidewire does not reach the true lumen or the same subintimal track made anterogradely. A 0.018″ diameter guidewire is probably the best option as it is still a delicate guidewire, but with more support than a 0.014″ guidewire. The tip should be soft and most probably hydrophilic to track easily the punctured vessel retrogradely. As no sheath should usually be introduced, hard push on the guidewire can lead to irreversible kinging of its body, which can jeopardize the intervention.

5.2.8 Pedal plantar loop technique

This technique consists in creating a loop with the guidewire from the anterior tibial artery to the posterior tibial artery, or the reverse, through the foot vessels [8, 9]. The most common pathway is through dorsalis pedis artery, deep plantar artery, deep plantar arterial arch, lateral plantar artery, and posterior tibial artery. Indications for this technique are similar to the retrograde access. However, it can be performed when no distal vessels are available for puncture, being also less invasive. Moreover, this technique can improve the outflow for tibial arteries.

However, complications related to foot vessels manipulation can precipitate a serious worsening of the ischemic condition. Taking this into account, the guidewire to be chosen to this technique needs to have a soft hydrophilic tip to easily track through tortuous foots vessels without damaging them. The body should also have reduced stiffness to track across the created loop, that’s why usually a 0.014″ guidewire is preferred.

Are you interested in learning more about Hydrophilic guide wire? Contact us today to secure an expert consultation!