1. Anatomy of Contemporary CTO Guidewires and Selection Criteria
Patrick L. Whitlow, MD
Director, Interventional Cardiology
Cleveland Clinic

2. Disclosure of Financial Interests
Research support : Abbott Vascular, Edwards LifeSciences
Consultant: ICON, Frantz Medical
Stockholder: Medtronics, Inc.

3. HI-TORQUE® and ASAHI® Guide Wires
HI-TORQUE® BMW Guide Wires
ASAHI® Guide Wires

4. ASAHI TruTorq™ Technology
SINGLE-JOINT
Stainless Steel
Platinum
JOINT-LESS
Platinum
TruTorq™ Technology incorporates a proprietary method of fusing the stainless steel to the platinum spring coils for a joint-less transition.

5. Fielder FC　
Unit ; (mm)
Urethan + Hydrophilic Polymer Coat ; 200
0.014Inch
PTFE Coat
It’s difficult to have tactile feelings from a polymer jacket wire such as Fiedler FC! Ochiai

7. HI-TORQUE WHISPER® MS & WHISPER® ES
Polymer cover with transitionless core designed for deliverability and distal access in tortuous anatomy

8. HI-TORQUE PILOT® 50
Full Polymer cover with Hydrocoat hydrophilic coating for designed for lesion access
Tip coils provide soft, shapeable tip and tactile feedback
Marker Band
Modified RESPONSEASE™ parabolic technology, designed for torque response and control while providing additional support1 .

9. Pilot Wires
Plastic jacketed hydrophilic coating with progressively more aggressive tip strength
Pilot < 1 gm
Pilot gm
Pilot gm
Available in 190( DOCable) or 300 cm lengths

10. Fielder FC 10

11. Shaping of the Wire Tip 1mm Fielder FC Fielder SION SION blue XT XT-R
ULTIMATE
blos3

12. Collateral Engagement Wire
Use a Workhorse wire that has good tip-shape retention and reasonable support to track the support device into an angulated segment without a long leading edge into the collateral.
Whisper MS, Runthrough, BMW, ProWater, Pilot 50, etc

13. Collateral Crossing Wires
Usually choose a Polymer Jacket Wire with a soft but Shapeable ~1 gm Tip that is not tapered
Fielder FC
Pilot 50 ( RunThrough, Whisper)
If extremely tortuous, consider a Fielder XT -- or Sion/ Sion Blue in the near future

14. Sion and Sion Blue Actone Actone Unit ; (mm) Hydrophilic Polymer Coat
0.014Inch
Rope
Actone
PTFE Coat
Silicon
Coat
Hydrophilic Polymer Coat
0.014Inch
Rope
Actone
PTFE Coat

15. Lesion Crossing Wires
Frequently chosen in an escalating strategy of soft/ safe tip first moving up to more powerful tips with more risk of dissection/ exit
I. Fielder XT ( Whisper, Pilot 50, RunThrough)
II. Pilot 200 Or CrossBoss
III. Knuckle Wire (Fielder XT>> Pilot 200)
IV. Confianza Pro 12 ( or some operators prefer 9 gm) ( Mir. Bros, Progress, ProVia)

16. ASAHI® MIRACLEBROS® Family – Straight Tip Guide Wires
Characteristics:
11 cm of Radiopacity
Joint-Less Technology
Increasing Tip Loads 3g-12g
Designed for challenging lesions
Increasing Support with increased Tip Stiffness
Hydrophobic Coating for tactile feedback and smooth device interaction

17. ASAHI CONFIANZA Pro® – Tapered Tip Guide Wires
Tapered Tip Designed for Lesion Crossability
ASAHI CONFIANZA PRO® 9
.009”
Hydrophobic Coating
19.9 cm
Hydrophilic Coating
1 mm Hydrophobic Coating
Characteristics:
Tip Load – 9.3g / 12.4g
Tapered Tip – 0.009”
20 cm Radiopacitiy
Joint-Less Technology
Hybrid Coating
ASAHI CONFIANZA PRO ® 12
.009”
Hydrophobic Coating
19.9 cm
Hydrophilic Coating
1 mm Hydrophobic Coating

18. HI-TORQUE PROGRESSTM Guide Wires Features
INTERMEDIATE POLYMER COVER with HYDROPHILIC COATING : Designed to maximize wire maneuverability while in the lesion
HYDROPHOBIC COATING: facilitates device movement over the proximal section of the wire
TAPERED TIP: ”, ”, 0.009”:
5mm EXPOSED TIP COILS:
Uncoated for “true” tactile feel in the lesion
CORE-TO-TIP STAINLESS STEEL: High tensile strength core material and transition less parabolic core eliminates prolapse points and minimizes kinking, delivering reliable steering and control
Product Overview:
The HI-TORQUE PROGRESS Family of Coronary Guide Wires is the next generation Chronically Stenosed Lesion (CSL) 0.014” wires. HT PROGRESS is a set of five guide wires, designed with a tapered tip and a variety of tip stiffness, for treatment of CSL’s. The wire features uncovered tip coils on the first 5mm of the tip, and a hydrophilic polymer sleeve that extends 29.5cm proximal to the uncovered tip.
3 cm radiopaque coils r

19. IMPORTANT CONCEPT: Penetration Power 40,80,120,140T,200T
Tip Stiffness = 4.0g
Tip Diameter 0.012”
Tip Stiffness
Area of GW Tip
Note: drawing not to scale
Area of GW Tip r
Penetration Power:
The wire HT PROGRESS 40, 80, 120, 140T and 200T, number is a calculation that defines the wires Penetration Power (tip stiffness in grams divided by the area of the guide wire tip), to assist physicians in choosing the most appropriate guide wire.  For example, if the HT PROGRESS 40 does not cross the lesion, the physician can choose HT PROGRESS 80, confidently knowing the wire has 2x the amount of Penetration Power as the HT PROGRESS 40.
Why Penetration Power? – it’s the complete measurement of the guide wire (Tip Stiffness and the Area of the GW Tip) 20

20. HI-TORQUE PROGRESS Family of Guide Wires Photos
0.012”
HT PROGRESSTM 40 / 80 / 120
0.009” & ”
HT PROGRESS TM 140 / 200
Photos property of Abbott Vascular and on file

21. Penetration Power Calculations
Guide Wire 
Manufacturer
Tip Stiffness (Load) (g)
Tip Diameter
Penetration Power (Tip Load/Area of Tip) (kg/in2)
Fielder XT
Asahi
1.2g
0.009” 19
CROSSWIRE
Terumo
4.2g
0.014” 27
MiracleBros 3
3.9g
0.0125” 32
Persuader 3
Medtronic
5.1g 33
MiracleBros 4.5
4.4g 36
Shinobi
Cordis
6.8g 44
Shinobi Plus
7.0g 45
CROSSWIRE NT
7.5g 49
Persuader 6
8.0g 52
MiracleBros 6
8.8g 72
Persuader 9
9.1g
0.011” 96
MiracleBros 12
13.0g
106
Confianza Pro 9
9.3g
146
Confianza Pro 12
12.4g
195
Tests performed by and data on file at Abbott Vascular

22. Externalization Wires
Need a long wire with reasonable support and pushability, usually with a polymer coating or jacket
Viperwire Advance cm peripheral wire
Pilot cm
Fielder FC cm
RotaWire Floppy cm
esp. with RotaGlide Solution