Historical Background
The age of endovascular therapy began with Dr. Sven Seldinger’s publication in 1953 of his technique for vascular access over a wire. The field expanded rapidly with subsequent seminal publications, including those by Dr. Charles Dotter, an American radiologist, in 1964 that demonstrated a technique to cross an atherosclerotic lesion. Indeed, Dotter was the first to describe flow-directed balloon catheterization, the double-lumen balloon catheter, the safety guidewire, and the “ J ” tipped guidewire. In his angiography laboratory in Oregon, Dotter and his technicians were the first to make wire guides and produced Teflon catheters using a blowtorch. These pioneering endeavors set the stage for Andreas Gruntzig, who developed the technique of balloon angioplasty, as well as Julio Palmaz, who designed the first balloon expandable stent in 1985.
Without first obtaining the basic skills of wire and catheter selection and manipulation, the interventionist cannot be successful with endoluminal therapies. To that end, the following text describes the basic concepts of selecting and utilizing various catheters and guidewires.
Guidewire Selection
Guidewires are available in many sizes, shapes, and compositions, which are dictated by their intended purpose ( Table 4-1 ). Their diameters are measured in inches, with standard sizes on which current endovascular platforms are based, including 0.035-, 0.018-, and 0.014-inch guidewires. Guidewire length is chosen based on the sum of the distance from the site of vascular entry to the site of intervention and the device platform, such as an over-the-wire or monorail system.
| Guidewire | Manufacturer | Tip Style | Features | Function |
|---|---|---|---|---|
| 0.035 inch | ||||
| Storq | Cordis | Straight, angled, modified J | Various stiffnesses, SLX (proprietary) coating, stainless steel core | Initial access, vessel selection, stable access for device delivery |
| Advantage | Terumo | Angled | Hydrophilic tip | Initial access, vessel selection, stable access for device delivery |
| Bentson | Boston Scientific | Long soft tip | Initial access, working wire for device delivery | |
| ZIPwire | Boston Scientific | Straight, angled, J | Hydrophilic polyurethane coating, nitinol core | Vessel selection, traversing complex lesions |
| Roadrunner Nimble | Cook Medical | Angled platinum | AQ (proprietary) hydrophilic coating, nitinol core | Vessel selection, traversing complex lesions |
| Rosen | Cook Medical | Tight curve | Stiff stainless steel wire | Stiff working wire for stable access and device delivery |
| Amplatz Super Stiff | Boston Scientific | Flexible straight, J | PTFE coating, extrastiff stainless steel core, short and long soft tip | Extrastiff working wire for stable access and device delivery |
| Meier Wire | Boston Scientific | Flexible C and J | PTFE coating, stiff stainless steel shaft | Superstiff wire for large sheath or device delivery (e.g., endograft delivery) |
| Lunderquist | Cook Medical | Straight, curved | TFE coating, superstiff stainless steel core | Superstiff wire for large sheath or device delivery (e.g., endograft delivery) |
| 0.018 inch | ||||
| ZIPwire | Boston Scientific | Straight, angled, J | Hydrophilic polyurethane coating, nitinol core | Small vessel selection (e.g., renal and tibial vessels), high-order vessel selection, traversing complex lesions |
| Thruway | Boston Scientific | Straight, J (shapeable) | Stainless steel core | Small vessel selection and intervention (e.g., renal and tibial vessels) |
| V18 | Boston Scientific | Straight (shapeable) | ICE (proprietary) hydrophilic coating, stiff Scitanium (proprietary) core | Small vessel selection and intervention, subintimal entry for angioplasty (off label) |
| 0.014 inch | ||||
| Hi-Torque Balance Middleweight | Abbott Vascular | Straight | Elastinite nitinol | Intended to facilitate placement of balloon dilatation catheters and stents |
| Hi-Torque Spartacore 14 | Abbott Vascular | Traversing chronic total occlusions | ||
| ASAHI MiracleBros 6 | Abbott Vascular | Traversing chronic total occlusions with controlled drilling technique | ||
| ASAHI Prowater | Abbott Vascular | Straight | Not specified | Traversing chronic total occlusions |
| ASAHI Confianza Pro 12 | Abbott Vascular | Straight | Not specified | Traversing chronic total occlusions with controlled penetration technique |
| ChoICE PT Extra Support Guidewire | Boston Scientific | Straight, J (shapeable) | Stainless steel core | High level of support designed for easier device delivery in highly resistant lesions |
| ChoICE PT Floppy Guidewire | Boston Scientific | Straight, J (shapeable) | Hydrophilic coating, stainless steel core | Hydrophilic-coated polymer sleeve with intermediate tip and flexible body for tortuous anatomy and resistant lesions |
| Journey | Boston Scientific | Straight, J | Hydrophilic coating, nitinol distal core | High level of support designed for easier device delivery in highly resistant lesions |
| Victory 18 or 30 | Boston Scientific | Straight | Stainless steel core | High-gram-load tip options (12-30 g) designed for cross-resistant lesions |
| Thruway | Boston Scientific | Straight, J (shapeable) | Stainless steel core | Small vessel selection and intervention (e.g., renal and tibial vessels), high-order vessel selection |
| Approach CTO Wire | Cook Medical | Straight (shapeable) | Stainless steel core, various tip weights (6, 12, 18, and 25 g) | Complex lesion crossing in large and small vessels |
Guidewires are composed of a nonhydrophilic metal but may be coated with a hydrophilic polymer film that once moistened affords a low friction surface. The hydrophilic coating can be on a portion of the tip or on the entire guidewire shaft. Hydrophilic guidewires should not be used for initial arterial entry because of the risk of shearing off the film coating with the beveled edge of the entry needle, as well as an increased risk of subintimal dissection. Aside from the guidewire type and diameter, other important characteristics include radiopacity; flexibility; “torquability” or “steerability,” which reflects the capacity to turn the guidewire tip; “trackability,” or the ability to pass the wire into the target vessel once the tip is engaged within the vessel orifice; and tip shape, which may be straight, angled, or J shaped ( Fig. 4-1 ).
