Basics of Guidewire Technology and Peripheral Artery Disease

Abstract

Guidewire technology has advanced significantly over the last several decades. As more components are incorporated providing valuable features, deciding which guidewire to use during peripheral artery disease (PAD) interventions has become more complex. The challenge for both the beginner and expert is not only understanding which components offer the best characteristics in a guidewire but choosing the optimal wire for an intervention. Manufacturers have attempted to optimize components to provide physicians with routinely available guidewires needed in everyday practice. Yet selecting the best guidewire for a particular situation during an intervention is still challenging. This article provides a basic overview of guidewire components and what benefits they offer during PAD interventions.

Keywords: coating; core; covers; guidewire components; guidewire features; interventional radiology; spring coils; tip design; tip load; tip penetrance.

Fig. 1

Key guidewire elements. (Adapted from image provided courtesy of Boston Scientific. © 2022 Boston Scientific Corporation or its affiliates. All rights reserved.)

Fig. 2

Long taper versus short taper guidewires. Long tapers aid in selecting and tracking into a branch vessel arising at an acute angle. Short taper wires have better support over short distances and prolapse easily, which is helpful during a subintimal recanalization but not for selecting branch vessels arising at an acute angle. (Image provided courtesy of Boston Scientific. © 2022 Boston Scientific Corporation or its affiliates. All rights reserved.)

Fig. 3

The spring coil design provides more tip resilience and tactile feel but more friction due to its grooves. A polymer jacket placed over a spring coil smooths out the grooves, which reduces friction and provides more lubricity thereby improving CTO crossability and device deliverability. (Image provided courtesy of Boston Scientific. © 2022 Boston Scientific Corporation or its affiliates. All rights reserved.)

Fig. 4

Electron micrography images showing how a polymer jacket over a spring coil smooths out its grooves. (Image provided courtesy of Boston Scientific. © 2022 Boston Scientific Corporation or its affiliates. All rights reserved.)

Fig. 5

Hydrophilic versus hydrophobic guidewire coatings. (Image provided courtesy of Boston Scientific. © 2022 Boston Scientific Corporation or its affiliates. All rights reserved.)

Fig. 6

Hydrophilic coatings and polymer jackets both result in increased lubricity with less tactile feel, whereas hydrophobic coatings result in decreased lubricity but improved tactile feel. (Image provided courtesy of Boston Scientific. © 2022 Boston Scientific Corporation or its affiliates. All rights reserved.)

Fig. 7

Guidewire tip load definition and how it is determined. (Adapted from image provided courtesy of Boston Scientific. © 2022 Boston Scientific Corporation or its affiliates. All rights reserved.)

Fig. 8

Guidewire tip penetrance increases as the tip diameter decreases and tip load increases. The higher the tip penetrance, the better a guidewire is at crossing a CTO but with increased risk of vessel perforation. (Image provided courtesy of Boston Scientific. © 2022 Boston Scientific Corporation or its affiliates. All rights reserved.)

Fig. 9

One example of choosing guidewire features based on CTO cap type, degree of calcification, presence of collaterals for transcollateral crossing, and vessel tortuosity. (Adapted from image provided courtesy of Boston Scientific. © 2022 Boston Scientific Corporation or its affiliates. All rights reserved.)