30.

5
Guidewires

Emmanouil S. Brilakis, MD, PhD

 PCI: the steps
1. Planning
2. Monitoring
3. Pharmacology
4. Access
5. Engagement
6. Angiography
7. Determine target lesion
8. Wiring
9. Lesion preparation
10. Stenting
11. Closure
12. Physiology
13. Imaging
14. Hemodynamic support
 Guidewire characteristics

DISTAL TIP COATING CORE

oTip Load oHydrophobic or none oThickness
oTaper oHydrophilic oMaterial
oPolymer jacket oTaper
 Guidewire classification
2. Polymer
1. Workhorse jacketed 3. Stiff 4. Support
+/- hydrophilic coating

Soft, non-
1. Nitinol 1. Whisper 1. Gaia, Judo 1. Ironman

tapered
• BMW, Minamo 2. Pilot 50 2. Confianza 2. Grand Slam
• Turntrac/Versaturn 3. Fielder FC Pro 12 3. Mailman
• Runthrough 4. Sion black 3. Hornet 14 4. Wiggle
2. Composite core 5. Fielder XT, XT-A, 4. Astato 20

tapered
• Sion blue, Suoh 03* Soft, XT-R
3. Dual coil 6. Fighter 5. Atherectomy
7. Bandit Rotafloppy - Viper
• Samurai RC
8. Pilot 200
4. Stainless steel 6. Externatization
Stiff

9. Gladius Mongo RG3, R350

• HT Floppy
10. Raider
7. Pressure
 1. Workhorse

Floppy forte
 1. Workhorse wires
Tip Stiffness Wire name Manufact Tip Hydrophilic tip coating Tip technology Tip radiopacity Material Comment

urer stiffness (cm)

(grams)
Ultra Low Tip Suoh 03 Asahi 0.3 Yes – 52 cm ACT ONE 3 Stainless steel Best wire for tortuous

Stiffness Intecc epicardial collaterals.

Low tip                

stiffness
  BALANCE Abbott 0.6 No Shaping 3 Nitinol  
MIDDLE Ribbon

WEIGHT
(BMW)

  BMW Abbott 0.6 Yes Shaping 3 Nitinol  

Universal Ribbon
  BMW Abbott 0.7 Yes Shaping 3 Nitinol  

Universal II Ribbon
  BMW Elite Abbott 0.8 Yes Core-To-Tip 3 Nitinol  

  TURNTRAC Abbott 0.8 Yes + No (version with no coating in distal 1 cm) Core-To-Tip 3 Nitinol  
Suoh 03
 ASAHI SION Guide Wire Design
Composite Core Technology (proximal portion)
Composite Core (distal portion) 1. Rope Coil
1. Flexible core 2. Flexible core
2. Twist wire 3. Twist wire

Stainless steel high tension core

3 cm Radiopaque SLIPCOAT hydrophilic coating coats

TM

Joint-less spring coil

coils entire working length of the wire (28 cm)
Inferior STEMI
 AL1 guide
Sion blue
Knuckle wiring
 2. Polymer-jacketed guidewires
Non-CTO and CTO PCI CTO PCI
Soft non-tapered Soft tapered Stiff
OLDER OLDER OLDER
Fielder FC Fielder XT Pilot 200
Pilot 50 Fielder XT-A PT2
Whisper Fielder XT-R  
Choice PT Fighter  
   

NEWER NEWER NEWER

Sion black Bandit Mongo
Raider
Sion black
 2. Polymer-jacketed guidewires
Non-CTO and CTO PCI CTO PCI
Soft non-tapered Soft tapered Stiff
OLDER OLDER OLDER
Fielder FC Fielder XT Pilot 200
Pilot 50 Fielder XT-A PT2
Whisper Fielder XT-R  
Choice PT Fighter  
   

NEWER NEWER NEWER

Sion black Bandit Mongo
Raider
 FighterCrossing
Fighter™ Specialty guidewire
Wire

Key Features

Tapered tip

Clear polymer jacket

Hydrophilic coating

Ideal prolapse wire

Moderate rail support

Polymer (Coil) Length (18cm)
0.014 inch
Radiopaque (3.5
cm)
0.009
inch

Clear Polymer Jacket & Stainless

PTFE
Hydrophilic Coating Steel Core
Coating
Coil
Tip Coil Radiopaqu Tip Core
Diamete Length Tip
Name Diamete length e Load Materia Coating
r (cm) (cm) Shape
r (cm) (gf) l
(inch)

Clear
190 Stainles Straigh Polymer
FIGHTER 0.014 0.009 18 3.5 1.5
300 s Steel t Jacket w/
Hydrophilic
 Bandit

• 0.8g tip load

• 0.008” tapered, shapeable tip
• 17cm of polymer jacket over 16cm of coil
• Radiopacity – 10cm
 2. Polymer-jacketed guidewires
Non-CTO and CTO PCI CTO PCI
Soft non-tapered Soft tapered Stiff
OLDER OLDER OLDER
Fielder FC Fielder XT Pilot 200
Pilot 50 Fielder XT-A PT2
Whisper Fielder XT-R  
Choice PT Fighter  
   

NEWER NEWER NEWER

Sion black Bandit Mongo
Raider
Pilot wires
Wiring through angulation
Gladius Mongo (Asahi)
ASAHI Gladius Mongo
Usable Length : 190/300 cm
Polymer jacket & Hydrophilic coating SLIP-COAT ： 41 cm PTFE coating

0.014 inch
High-tension stainless steel core
Coil Length 8.5 cm

Diameter ：　 0.014 inch

Tip load ：　 3.0 gf
Coating length ：　 41 cm
Usable length ：　 190/300 cm

ASAHI Gladius Mongo ES ※ES Extra support

Usable Length : 190/300 cm

Polymer jacket & Hydrophilic coating SLIP-COAT ： 10 cm PTFE coating

0.014 inch
High-tension stainless steel core
Coil Length 3.0 cm

Diameter ：　 0.014 inch

Tip load ：　 3.0 gf
Coating length ：　 10 cm
Usable length ：　 190/300 cm
 Pilot 200

Gladius Mongo
 Raider

• Second escalation/knuckling guidewire

• 4g tip load
• Shapeable tip
• 30cm of polymer jacket over 25cm of coil
• Radiopacity – 10cm length
• Stainless steel core construction
• HPC length – 30cm length
• 200cm and 300cm working length
 3. Stiff wires (moderate)

Name Tip diameter Stiffness (g) Company Coating Radiopaque

segment (cm)
Gaia 1st, 2nd, 3rd 0.010”, 0.011”, 1.7, 3.5, 4.5 Asahi Intecc Hydrophilic 15
0.012”

Judo 1, 3, 6 0.008” 1, 3, 6 BSci Hydrophilic 3.5

Ultimatebros 3 0.014” 3 Asahi Intecc Hydrophilic 11

Gaia Next 0.011”, 0.012”, 2, 4, 6 Asahi Intecc Hydrophilic

0,012”
 30

ASAHI Gaia guidewires

Total Length 1900mm

SLIP-COAT® Coating Length 400mm

0.36mm
Coil Length 150mm PTFE coat
(0.014inch)

Various models for different situations and/or lesions

ASAHI Gaia First Diameter ： 0.26mm (0.010”) - 0.36mm (0.014”)

Tip load ： 1.7gf
ASAHI Gaia Second Diameter ： 0.28mm (0.011”) - 0.36mm (0.014”)
Tip load ： 3.5gf
ASAHI Gaia Third Diameter ： 0.30mm (0.012”) - 0.36mm (0.014”)
Tip load ： 4.5gf
 Lesson
Understanding
where you are
going helps you
get there

Understanding where you

are going

(Gaia 2nd and Micro 14)

 JUDO Guidewire Specifications
Designed with Micro EMT technology to have an ultra low crossing profile and exceptional
steerability, JUDO Guidewires are ideal intraluminal crossing wires for complex lesions.
6 cm taper Stainless steel core PTFE Coating

0.008”
Diamete 3.5 cm 15 cm spring coil w/ Compatible w/ STRETCH
r radiopaque hydrophilic coating Extension Wire

Penetratio
Expected Clinical Tip Load Diamete Radiopaqu Tip Coil Distal Core Rail
Wire n Force Cover
Application (gf) r e Length Style Length Coating Material Support
(gf/mm2)

Soft intraluminal crossing

JUDO 1 wire for antegrade 1.0 31
microchannels
0.008”
Intermediate intraluminal tip
Core- Spring Hydrophili Stainles Moderat
JUDO 3 crossing wire for fibro- 3.0 93 3.5 cm 15 cm
to-tip Coil c s Steel e
calcific lesions 0.014”
proximal
Increased penetration and
JUDO 6 excellent steerability in 6.0 185
tight lesions
Gaia Next (Asahi)

This wire is NOT FDA Approved in the US

Gaia Next (Asahi)

This wire is NOT FDA Approved in the US

 3. Stiff wires (very)

Name Tip diameter Stiffness (g) Company Coating Radiopaque

segment (cm)
Confianza Pro 9, 12 0.009” 9.3,12.4 Asahi Intecc Hydrophilic 20

Hornet 10, 14 0.008” 10, 14 BSci hydrophilic 3.5

Astato 20 0.008” 20 Asahi Intecc

Progress 140T, 200T 0.0105”, 12.5, 13.3 Abbott Hydrophilic

0.009” Vascular
Persuader 9 0.011” 9.1 Medtronic

Provia 9, 12 0.009” 11.8, 13.5 Medtronic

 3. Stiff wires
Asahi Miracle/Confianza wire family

For delivering
Stingray balloon
Confianza = tapered tip
 Hornet wire family

Coil Length(15cm) / Hydrophilic Coating

0.014 inch
Radiopaque (3.5 cm)
0.008 inch

Stainless Steel
Hydrophilic Coating PTFE Coating
Core
Coil Tip Total Coil Radiop- Tip Penetratio
Core Tip
Name Diameter Diameter Length Length aque Load n Force Coating
Material Shape
(inch) (inch) (cm) (cm) (cm) (gf) (gf/mm2)

190 Stainles
Hornet 0.014 0.008 15 3.5 1 31 Straight Hydrophilic
300 s Steel

190 Stainles
Hornet 10 0.014 0.008 15 3.5 10 308 Straight Hydrophilic
300 s Steel

190 Stainles
Hornet 14 0.014 0.008 15 3.5 14 432 Straight Hydrophilic
300 s Steel
Impact of microcatheter on guidewire tip stiffness

Waksman, Saito. Chronic total occlusions: a guide to revascularization. Wiley-Blackwell; 2013.

 CTO antegrade wire escalation

1 Fielder XT - Fighter
Course of occluded
vessel known?
yes no

2 Gaia 3 Pilot 200

2nd

Heavily
calcified
4 Confianza Pro 12 – Hornet 14

Brilakis ES. Manual of coronary CTO interventions. Elsevier 2017

 4. Support wires
Wire category Tip Style Commercial name Tip stiffness Manufacturer Properties

Extra support Soft, non-tapered BHW (nitinol) 0.8 gr Abbott Vascular 190 cm and 300 cm long

guidewires
Extra S’port 0.9 gr

All Star 0.8 gr

Iron Man 1.0 g

Grand Slam 0.7 g Asahi Intecc 180 and 300 cm long

Sion blue extra 0.5 g

support

Mailman 0.8 g Boston Scientific 182 and 300 cm long

Wiggle wire Curved distal Wiggle 1.0 g Abbott Vascular 190 cm and 300 cm long

portion
Wiggle wire
Distal RCA
lesion
RCA wired
Ironman
300 cm
 Guide
removed
over 0.014”
Ironman
 MPA1
engaged
RCA
5. Atherectomy guidewires

Viperwire Advance
Viperwire Advance Flex Tip

0.012 inch
6. Externalization guidewires

RG3
 7. Pressure wires & microcatheter

Piezoelectric Pressure ACIST Optical Fiber

Wires (Abbott & Philips) Microcatheter
Electrical sensor
2nd Gen Fiber
Optic
(Opsens)
Optical fiber

3 electrical cables

2nd Generation Fiber Optic

1st gen Fiber Optic sensor
(Opsens)
(BSC, Acist)
Electrical sensor

Courtesy: Morton Kern, MD

 Physiologic indices

Hyperemic Non-hyperemic

Diastolic -
Full cycle subcycle

FFR cFFR Pd/Pa RFR DFR dPR DPR iFR

All All All systems Abbott BSci ACIST Opsens Philips
systems systems
≤0.91 ≤0.89 ≤0.89 ≤0.89 ≤0.89 ≤0.89
≤0.80 ≤0.83
 Guidewire selection simplified
1. Non-complex lesions: workhorse
2. Tortuosity: workhorse, workhorse+ hydrophilic coating,
soft non-tapered polymer-jacketed, Suoh 03
3. CTO antegrade: Polymer jacketed tapered, Gaia, Pilot
200
4. CTO retrograde: Sion, Suoh 03, Sion black, Fielder FC
5. Calcified CTOs: Confianza Pro 12, Hornet 14, Astato 20
6. Delivery: support wires, Wiggle wire
7. Atherectomy wires: wire with workhorse then change
 0.035 inch wires

Standard Non-jacketed, Polymer- Support

soft jacketed

J-tip (3 mm 1. Bentson 1. Glidewire 1. Amplatz

radius) 2. Wholey 2. Glidewire Superstiff
3. Storq Advantage 2. Supracore
3. Glidewire 3. Lunderquist
baby-J (1.5
mm radius)
 Tortuosity

NEVER PUSH
HARD!!!

Wholey wire
 Guidewire classification
2. Polymer
1. Workhorse jacketed 3. Stiff 4. Support
+/- hydrophilic coating

Soft, non-
1. Nitinol 1. Whisper 1. Gaia, Judo 1. Ironman

tapered
• BMW, Minamo 2. Pilot 50 2. Confianza 2. Grand Slam
• Turntrac/Versaturn 3. Fielder FC Pro 12 3. Mailman
• Runthrough 4. Sion black 3. Hornet 14 4. Wiggle
2. Composite core 5. Fielder XT, XT-A, 4. Astato 20

tapered
• Sion blue, Suoh 03* Soft, XT-R
3. Dual coil 6. Fighter 5. Atherectomy
7. Bandit Rotafloppy - Viper
• Samurai RC
8. Pilot 200
4. Stainless steel 6. Externatization
Stiff

9. Gladius Mongo RG3, R350

• HT Floppy
10. Raider
7. Pressure