Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3764_Библиотеки_им_академика_М_И_Перельмана
.pdf
7
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
CHAPTER 7
New Coronary Guidewire
Technology in Chronic Total
Occlusion Percutaneous Coronary
Interventions
Salman Allana* & Emmanouil S. Brilakis*
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
*Corresponding authors
With advancement in technology and development of
treatment algorithms, the success of chronic total
occlusion (CTO) percutaneous coronary intervention
(PCI) has increased [1, 2]. This improvement is at
least in part due to developments in coronary guidewire technology.
Coronary 0.014 inch guidewires are essential for
CTO PCI and can be classified into 7 categories:
1 Workhorse
2
Polymer-jacketed
3
Stiff-tip
Support
4
5
Atherectomy
Externalization
6
7 Pressure wires
In this chapter we discuss recent developments in
workhorse, polymer-jacketed, and stiff-tip guidewires
that are frequently used in CTO PCI.
Workhorse guidewires
Workhorse guidewires are used in most non-CTO
PCIs and are also used during CTO PCI after successful crossing of the occlusion to minimize the risk of
distal vessel injury or perforation during equipment
delivery. The key characteristics of workhorse guidewires are:
(a) Soft tip (usually 1 gram or less tip load), and
(b) No polymer jacket
Other characteristics of workhorse guidewires include:
a) Hydrophilic coating. Several workhorse guidewires
have a hydrophilic coating (which is different than
a full polymer jacket). As anticipated, hydrophilic
coating increases deliverability but decreases tactile
feedback and increases the risk of vessel injury.
b) Material: most wires are made of stainless steel. Niti-
nol wires, such as the Runthrough (Terumo) and the
recently introduced Minamo wire (Asahi Intecc) have
better tip shape retention but can be harder to shape.
c) Construction of the tip: most guidewires have
a wire coil around a central core. The central coil
might extend to the tip of the wire (core to tip) or
a shaping ribbon might be added to allow easier tip
shaping, which is commonly used in nitinol wires.
Some wires have multiple cores (ACT-ONE technology), such as the Sion (Figure 7.1), Sion blue,
and Suoh 03 (Figure 7.2) (Asahi Intecc), whereas
other wires have dual coils, such as the Samurai
and Samurai RC (Figure 7.3, Boston Scientific) that
improve guidewire handling.
Although often not considered a “workhorse”
wire, the Suoh 03 (Figure 7.2) is the softest tip guidewire currently available (0.3 gram tip load). Besides
having the inner coil, the distal 3 cm of the outer
rope coil consists of 4 intertwined wires. This dual
twisted coiled structure allows high torqueability
Chronic Total Occlusions: A Guide to Recanalization, Third Edition. Edited by Ron Waksman and Shigeru Saito.
© 2024 John Wiley & Sons Ltd. Published 2024 by John Wiley & Sons Ltd.
49
50 PART III Wires Technology
Figure 7.1 Construction of the Sion guidewire. Reproduced with permission from Asahi Intecc.
Figure 7.2 Illustration of the Suoh 03 guidewire. Reproduced with permission from Asahi Intecc.
and steerability. The Suoh 03 has a 19 cm long coil
and a hydrophilic coating in its distal 52 cm. It is one
of the most frequently used wires for retrograde
crossing of both septal and epicardial collaterals and
is the wire of choice for crossing epicardial collater-
als. In the PROGRESS CTO registry, it was one of
the top three most successful coronary guidewires
for collateral crossing [3]. The Suoh 03 can also be
useful in wiring through dissected coronary segments [4].
CHAPTER 7 New Coronary Guidewire Technology in Chronic Total Occlusion Percutaneous 51
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
Figure 7.3 Illustration of the Samurai and Samurai RC guidewire. Image provided courtesy of Boston Scientific. ©2022
Boston Scientific Corporation or its affiliates. All rights reserved.
52 PART III Wires Technology
Polymer-jacketed guidewires
The tip of the polymer-jacketed guidewires is fully
covered by a very slippery polymer.
There are three major categories of polymer-jacketed guidewires based on tip load and distal tapering
(Table 7.1).
•
Soft, non-tapered guidewires.
•
Soft, tapered polymer jacketed wires that are usu-
ally the first choice for antegrade CTO crossing and
are also often used to form knuckles for dissection
re-entry.
•
Stiff-tip polymer jacketed wires that are commonly
used in CTO PCI during both antegrade and retro-
grade wiring, knuckling, and for reentry into the
true lumen
Polymer jacketed wires are commonly used in both
antegrade and retrograde CTO PCI due to their
favorable safety profile when compared with stiff tip
guidewires [3]. Polymer-jacketed wires should be
exchanged for workhorse wires after CTO crossing to
minimize the risk of complications during attempts
for equipment delivery [5].
Table 7.1 Overview of polymer-jacketed guidewires. Newer wires are in bold font.
Soft, non-tapered polymer-jacketed
guidewires
The Sion black and Fielder FC wires (Figure 7.4, Asahi
Intecc) are the most commonly used soft, non-tapered,
polymer jacketed guidewires. The Sion black is built
based on the ACT ONE technology and is more
torqueable.
Soft, non-tapered, polymer-jacketed wires are very
useful for crossing tortuous coronary segments. The
Sion black is frequently used for crossing both septal
and epicardial collaterals.
Soft, tapered polymer-jacketed
guidewires
The Bandit (Figure 7.5, Teleflex), Fielder XT, Fielder
XT-A, Fielder XT-R (Figure 7.6, Asahi Intecc), and the
Fighter (Figure 7.7, Boston Scientific) are soft, tapered,
polymer jacketed guidewires. These wires are usually
the first choice for antegrade wiring and are also frequently used for knuckling. In a study of 164 consecutive CTO lesions with a mean J – CTO score of 3.71±1.27
treated with primary antegrade wiring strategy, use of
Tip Style Commercial
name
Soft,
Non-Tapered
Soft, Tapered Bandit 0.8 Teleflex Front-line wire for antegrade CTO crossing.
Stiff Gladius 3 Asahi Intecc Non-CTO PCI: difficult to penetrate lesions.
Choice PT 1.5 Boston Scientific Non-CTO PCI: Wiring through tortuosity.
Floppy
Fielder FC 0.8 Asahi Intecc
Sion Black 0.8 Asahi Intecc
Pilot 50 Abbott Vascular
Whisper LS,
MS, ES
Fielder XT
Fielder XT-A
Fielder XT-R
Fighter 1.2 Boston Scientific
Gladius Mongo
Gladius Mongo
ES
Pilot 150 | 200 2.7 | 4.1 Abbott Vascular
PT2 Moderate
Support
Raider 4.0 Teleflex
Tip
stiffness
(grams)
2.1 Boston Scientific
0.8, 1.0,
1.2
0.8
1.0
0.6
3
(designed
for
knuckling)
2.9 Boston Scientific
Manufacturer Properties
Abbott Vascular
Asahi Intecc
Asahi Intecc
CTO PCI: collateral vessel crossing.Choice PT
Can also be used for knuckle wire formation
and for retrograde crossing. Fielder XT-R is
designed for retrograde collateral crossing.
CTO PCI: Antegrade crossing, especially when
the course of the occluded vessel is unclear.
Also useful for knuckle wire formation
(Gladius
Mongo is specifically designed for knuckling)
and for reentry into the true lumen during
antegrade dissection and reentry.
Reproduced with permission from the Manual of CTO PCI.
CHAPTER 7 New Coronary Guidewire Technology in Chronic Total Occlusion Percutaneous 53
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
Figure 7.4 Illustration of the Sion black and Fielder FC wires. Reproduced with permission from Asahi Intecc.
the Fielder XTA and Fielder XTR in low to intermediate
complexity J-CTO score lesions of 0–1 and 2–3 achieved
technical success rate of 79% and 60% respectively with
a very low complication rate [6]. In another study, the
use of Fielder XT guidewire in low complexity CTOs
(J-CTO of 0–1 in 89.7% of patients) was associated with
shorter procedure time, higher success rate and lower
complications rates [7].
Raider (Figure 7.10, Teleflex) are stiff tip (3 grams for
the Gladius, Gladius Mongo, and Gladius Mongo ES,
and 4 grams for the Pilot 200 and Raider), tapered
polymer jacketed guidewires. These wires are used for
both antegrade and retrograde crossing as well as during antegrade dissection/reentry (swap wires for
Stingray-based reentry). They can also be used for
knuckling: the Pilot 200, Gladius, and Raider guidewires make large knuckles, whereas the Gladius
Stiff, polymer-jacketed guidewires
The Gladius (Figure 7.8, Asahi Intecc), Gladius
Mongo and Gladius Mongo ES (extra support) (Figure
7.9, Asahi Intecc), Pilot 200 (Abbott Vascular) and
Mongo is designed to create smaller knuckles. In the
PROGRESS CTO registry, the Pilot 200 was the most
frequently used guidewire for antegrade crossing and
also the most successful guidewire in both antegrade
54 PART III Wires Technology
Figure 7.5 Illustration of the Bandit wire. Reproduced with permission from Teleflex
and retrograde CTO crossing [3]. In another study,
the Pilot series of wires was the most successful wire
in antegrade CTO crossing [8].
The Gladius Mongo has good torque response and
maneuverability due to composite core (ACT ONE)
technology. It forms small knuckles and has become
one of the wires of choice for dissection re-entry. Due to
modified distal core balance leading to high tip durability, the maneuverability is maintained even after the
wire tip prolapses. The Gladius Mongo ES (extra support wire) has a stiffer body when compared to the
Gladius Mongo, shorter spring coil length (3.0 instead
grams) or high (≥9 grams). There are 4 major
groups of stiff-tip non-polymer-jacketed guidewires
(Table 7.2).
Stiff-tip guidewires are predominantly designed for
crossing resistant proximal and distal caps during
CTO PCI, however are also used when areas of resistance are encountered within the body of the occlusion. These guidewires can easily exit the coronary
vessel architecture leading to perforation. Therefore,
once the cap is punctured, it is important to de-escalate to a softer tip wire depending on anatomy and
crossing strategy.
of 8.5 cm for the Gladius Mongo), and shorter coating
length (10 cm vs. 41 cm for the Gladius Mongo).
Non-tapered stiff guidewires
The UltimateBros 3 (Figure 7.11, Asahi Intecc)
Stiff-tip non-polymer jacketed
guidewires
Stiff-tip non-polymer-jacketed guidewires are classified based on: (a) tip tapering (usually to 0.008 or
0.009 inch); and (b) tip stiffness: intermediate (<9
wire has a non-tapered tip and good torque
response and is sometimes used for antegrade wiring. It is a good choice in recanalization of mixed
morphology lesions due to long hydrophilic coating that maintains high maneuverability in highly
stenosed lesions.
CHAPTER 7 New Coronary Guidewire Technology in Chronic Total Occlusion Percutaneous 55
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
Figure 7.6 Illustration of the Fielder XT, Fielder XT-A, and Fielder XT-R wires. Reproduced with permission from
Asahi Intecc.
Figure 7.7 Illustration of the Fighter wire. Image provided courtesy of Boston Scientific. ©2022 Boston Scientific
Corporation or its affiliates. All rights reserved.
Tapered, intermediate tip stiffness
guidewires
Tapered-tip, intermediate tip stiffness guidewires
include the Gaia family of wires (Figure 7.12, Asahi
Intecc), Gaia Next family of wires (Figure 7.13, Asahi
Intecc) and the Judo family of wires (Figure 7.14,
Boston Scientific). These guidewires are commonly
used for both antegrade and retrograde crossing. They
56 PART III Wires Technology
Figure 7.8 Illustration of the Gladius wire. Reproduced with permission from Asahi Intecc.
Figure 7.9 Illustration of the Gladius Mongo wire. Reproduced with permission from Asahi Intecc.
Figure 7.10 Illustration of the Raider wire. Reproduced with permission from Teleflex.
CHAPTER 7 New Coronary Guidewire Technology in Chronic Total Occlusion Percutaneous 57
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
Table 7.2 Overview of stiff-tip guidewires. Newer guidewires are highlighted.
Tip Style Commercial name Tip stiffness
(grams)
Non-Tapered,
Intermediate
stiffness
Non-Tapered,
High stiffness
Tapered,
Intermediate
stiffness
Tapered, High
stiffness
Miracle 3 3 Asahi Intecc Antegrade wiring.
Miracle 6 6 Asahi Intecc
Ultimatebros 3 Asahi Intecc
Miracle 12 12 Asahi Intecc Antegrade wiring.
Gaia 1 1.7 Asahi Intecc Antegrade and retrograde
Gaia 3 4.5 Asahi Intecc
Gaia Next 1 2 Asahi Intecc
Gaia Next 2 4 Asahi Intecc
Gaia Next 3 6 Asahi Intecc
Judo 1 1 Boston Scientific
Judo 3 3 Boston Scientific
Judo 6 6 Boston Scientific
Astato 20 20 Asahi Intecc Penetration of highly
Confianza Pro 12 12 Asahi Intecc
Hornet 10 10 Boston Scientific
Hornet 14 14 Boston Scientific
Stingray 12 Boston Scientific
Infiltrac 11 Abbott Vascular
Infiltrac Plus 14 Abbott Vascular
Warrior 14 Teleflex
Manufacturer Properties
Facilitate delivery of
Stingray balloon to reentry
zone
Facilitate delivery of
Stingray balloon to reentry
zone
wiringGaia 2 3.5 Asahi Intecc
resistant capsConfianza Pro 9 Asahi Intecc
Reproduced with permission from the Manual of CTO PCI.
Figure 7.11 Illustration of the Ultimate 3 wire. Reproduced with permission from Asahi Intecc.
are often used after failure of polymer-jacketed
tapered tip guidewires to cross the CTO, if the course
of the vessel is well understood.
The Gaia guidewires have the ACT ONE technology designed to enhance torqueability and maneuverability, but require slower, more meticulous and
precise manipulation compared with other CTO
guidewires. They have a micro-cone tapered tip for
smooth lesion entry. The tip core is round instead of
flat and has a composite core consisting of stainlesssteel tube rope coil with traditional spring-coil on the
exterior (composite core: dual coil construction). The
Соседние файлы в папке Библиотека им академика М.И. Перельмана