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IVUSAID

IVUS imaging cases quizzes and more

DeviceAID

Information on hundreds of PCI devices

iPhone app coming soon!

MCSAID

Using mechanical cardiocirculatory support

GuidewireAID

Learn about coronary wires & microcatheters

BifurcAID 3D

3D animations of bifurcation stenting

TAVRcathAID

Tips on post-TAVR coronary reaccess

STEMIcathAID

Clinical tool at MSH for STEMI transfers

ComplicAID

Managing common complications of PCI

OCTAID

OCT imaging explained through examples

CalcificAID

Calcific lesion preparation
before stenting

TranseptAID

Transeptal puncture in various procedures

BifurcAID

Bifurcation stenting techniques illustrated

GuidewireAID

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Simple/Uncomplicated Lesion

Properties
Examples

To treat simple, concentric stenosis of the artery, the vital element of the wire is safety.
As these wires are not required to go through difficulty or extreme anatomies, unique properties are not required.
The wire should have an atraumatic tip, good torquability, and favorable trackability with a spring coiled nitinol wire.

Runthrough
Balance MiddleWeight
Sion Blue

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Tortuous Vessel

Properties
Examples

In dealing with tortuous anatomy, the workhorse wires aren't designed to tackle this challenging lesion and often fail to navigate through the lesion.
The presence of wire's flexibility, lubricity, and excellent trackability is essential to tackle these challenging anatomy.
The optimal wire should have a soft tip, polymer/hydrophilic cover, moderate support, or a hybrid type with a hydrophilic body and hydrophobic distal tip.

Fielder
Whisper
Pilot 50
CHOICE Floppy

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Calcified Lesion

Properties
Examples

Two distinct components are involved in a calcific lesion wiring:
1. crossing the lesion
2. delivering the devices
The ideal wire to cross a heavy calcified lesion should have a soft tip with polymer/hydrophilic cover or a hybrid type of wire (hydrophobic tip and hydrophilic body).
To deliver PCI devices through calcified lesion, the wire's crucial characteristics include high support, good tactile feedback, and excellent torquability/trackability for device delivery in a calcified lesion.

Crossing the lesion:

Runthrough
Fielder
Whisper
Pilot 50

Delivering the devices:

Iron Man
Mailman
Hi-Torque Balance HeavyWeight
Hi-Torque All-Star
CHOICE Extra Support with the buddy wire technique

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Bifurcation Lesion

Properties
Examples

The guidewire properties to tackle the lesion should include slipperiness, excellent trackability, and slightly stronger tip load. It is paramount not to choose those with a higher risk of wire retrieval damage (e.g., non-polymer-coated wires) as the wire might be jailed during the procedure.
Occasionally, aggressive wire with more tip stiffness along with a microcatheter may be required to enter the side branch in a challenging case.

Workhorse wire (main branch)

Runthrough
BMW
CHOICE Floppy

Polymer-coated wire (jailed side branch)

Fielder
Whisper
Pilot 50

Challenging case (side branch)

Gaia 2
MiracleBros 3

along with microcatheter

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Thrombotic Occlusion

Properties
Examples

In a setting of an acute thrombotic lesion, the wire shouldn't have significant resistance while traversing a lesion.
The main objective is to cross the occlusion and advance the wire to the distal lumen softly and atraumatically.
A soft wire would be the choice rather than a stiffer one with the hydrophilic or coated property. The operator can use any workhorse wire in this situation.
In subacute occlusions, the thrombus material could have become more organized and may require a stiffer tip and higher tip load to facilitate in crossing the lesion.

Fielder
Gaia series
MiracleBros 3

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Angulated Lesion

Properties
Examples

The wire properties to navigate the angulated lesion is torquability, trackability, and wire flexibility. The ideal wire would be a soft tip with polymer jacket and hydrophilic cover.
However, we may require stiffer tip with hydrophobic coating at the tip to have a better tactile feedback with torquability.
Sometimes, we may require additional devices to navigate an angulated lesion or when re-crossing a jailed side branch.

Fielder
Whisper
Pilot 50

Better tactile feedback with torquability:

MiracleBros
Provia

Additional devices:

Angulated microcatheter
Dual lumen catheter

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Workhorse Wires

Properties
Examples

Safety
1:1 torque
Moderate support
Excellent tip shape retention
Durable/resist tip breakage

BMW
Cougar
Hi-Torque Floppy
Hi-Torque Turntrac
Hi-Torque Versaturn
Runthrough NS
Samurai RC
Sion Blue

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Extra Support

Properties
Examples

Provide more support for tortuous anatomy & distal lesions
Does not spring back
Soft gentle tip

CHOICE Extra Support
Grand Slam
Hi-Torque All Star
Hi-Torque Balance Heavyweight
Hi-Torque Ironman
Mailman

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Frontline Finesse

Properties
Examples

1:1 torque
Excellent trackability through tortuosity
Single core
Moderate support
Low frequency of perforation
Avoid subintimal passage
Lubricity with tactile feedback

Bandit
Fielder FC
Fielder XT-A, XT-R
Fighter
Hi-Torque Pilot 50
Hi-Torque Whisper ES
Raider
Sion Black

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Specialty

Properties
Examples

Variety of tip stiffness and/or tip tapers for excellent crossability
Tip shape retention
Moderate support
Low frequency of perforation

Confianza Pro 9-12
Fielder FC, XT-A, XT-R
GAIA/GAIA Next
Gladius Mongo
Hi-Torque Cross-IT 100 XT
Hi-Torque Pilot 150, 200
Hi-Torque Progress 40/200
Hornet 10, 14
Miraclebros 3-12
RG3, R350
SION and SION Black

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AWE Stepwise Approach

Fielder (Non tapered polymer jacket tip), Fielder XT/XT-A/XT-R (Tapered polymer jacket tip)
MiracleBros (Open Coil, Straight tip, high tip stiffness > facilitate for drilling and can create the curve) OR Gaia 3 (Tapered, hydrophilic coating, composite core with 1:1 torque, high tip stiffness)
Confianza 9/12 (Tapered, hydrophilic coating, high tip stiffness)

ANTEGRADE CASES

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Wires for Microchannel Tracking

Fielder, Fielder XT, Fielder XT-A
Gaia 1, Gaia 2
High torque Pilot 50/150

ANTEGRADE CASES

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Wires for Crossing Proximal Cap

Fielder, Fielder XT/XT-A/XT-R (find microchannel)
Gaia 2, Gaia 3
MiracleBros 3, 4.5, 6
Confianza Pro

ANTEGRADE CASES

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Wires for Drilling

MiracleBros 6/12
Confianza Pro 9, 12
Pilot 200
Progress 200T

If the vessel course is ambiguous:

Pilot 200
Confianza Pro
Hornet 10, 14

ANTEGRADE CASES

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Wires for Navigating Through the Vessel

Gaia/Gaia Next Series
MiracleBros 4.5, 6
Confianza Pro
Ultimatebros 3
Progress 140T, 200T

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Wires for Distal Cap Crossing

Confianza Pro 12 (calcified distal cap)
Progress 200T
Hornet 14
Astato 20, 40

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Wires for Collateral/Septal Branches

Fielder, Fielder FC, Fielder XT-R
Sion Black
Suoh 03