Guidewires 16/7/08 10:08 Page 38
Interventional Cardiology
With two-vessel angioplasty I always look to see if I can use the Can you summarize your thoughts about the overall
same wire for the next lesion—can it cross into the side branch after I put importance of using the appropriate workhorse guidewire
in a stent? Runthrough is one of the wires that I use to get access to the to a successful procedural and patient outcome?
side branches.
Rutherford
What are the three most important attributes you I think, number one, it is mandatory that you can approach a patient with
require from your current workhorse wire (torque, a very user-friendly wire that will allow passage of the wire quickly and
trackability, support, tip stiffness, durability, etc.)? easily with no damage to the endothelium or to the artery—that is
Does this new hybrid wire possess all of these absolutely critical. Guidewires are often the unsung heroes of
attributes? How is it differentiated? angioplasty, and there has probably been a lot less time spent on
developing wires in the past few years than there could have been.
Moses
There are several aspects: you want versatility; you want one that steers We perform a lot of CTOs here at St Luke’s, and we are always looking
well but has a durable tip for a workhorse; you want it to have enough for improvements: wires with specialty tips that are either hydrophilic or
body for traction of your devices; and you want a decent transition that non-hydrophilic, and either tapered or non-tapered, so that we have a
is versatile enough to go through different angulations. little more advantage and a little more steerability in getting through
these completely occluded vessels.
Goldberg
I think torqueability is the most important attribute, followed by safety Sharma
of passage, the tip, and tactile feedback. I think the Terumo has all of Guidewire selection and advancement remains an integral part of
these attributes. interventional procedure and teaching to the fellows. Therefore, this part
of the PCI procedure has to be consistent and reliable with no surprises.
Making the right tip bend and selecting the appropriate guidewire are
very important for the successful performance of an interventional
procedure, especially if the vessel is diffusely diseased.
In my opinion, torqueability followed by
trackability and then support are the
Goldberg
Well, every procedure has to start with certain basics. You need
three most important attributes of a good guide catheter support and a wire that you feel can confidently
good workhorse wire.
cross the lesion. If you are struggling because the wire is non-torqueable,
it loses its tip shape, or you cannot really get a good feeling of it
for control, obviously the procedure will be more difficult. Also, as
you are entering arteries that come off at sharp angulations, you
want to be able to shape the tip appropriately and steer the wire
Rutherford in such a way that you minimize the time spent in passage and in
I agree that the two most important features are first, torquability, and lesion in these challenging cases. You also want to be able to slide your
second, having a soft, flexible, atraumatic tip to the wire—but for me, balloons and stents over the wire in such a way that there is smooth
number three is to provide enough support to allow free passage of passage. You do not want the wire to become an impediment to crossing
stents and balloons. Although the Runthrough scores very highly on the a lesion with your dilatation and stent equipment. These attributes are
first two attributes, I think the body of the Runthrough wire is not always the basis of the guidewire, and are extremely important—once you
stiff enough to support the passage of balloons and stents in complex or have control of the vessel with the wire, the rest of the case usually goes
calcified angulated anatomies. pretty well.
Parashara Moses
First, a guidewire should be really steerable in order to get to difficult Each individual operator obviously has to be comfortable with the
lesions. Second, it needs to have good strength to get equipment to handling characteristics of his or her guidewire. Devices have to match
the lesions. Third, it should be easily shaped to get around the angles and the operator, and people have different styles, so one size does not fit all.
to get to the lesion you want. I am not sure there is a perfect workhorse just yet. We are getting better:
the Runthrough has helped in moving in that direction, but the
Sharma technology can still advance further.
In my opinion, torqueability followed by trackability and then support are
the three most important attributes of a good workhorse wire. In Parashara
addition, the wire should be safe and not cause perforation. I was able It is important to pick a wire you feel comfortable with and that is also
to find all of these attributes in the Runthrough wire. I have used this appropriate for the difficulty of the procedure. It needs to be steerable,
wire over 500 times now and am very pleased with the performance and and once it gets through it needs enough strength to deliver the
the lack of perforation due to the hydrophobic tip. equipment to the lesion area. Those are the main factors. ■
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