Basic CTO Guidewires and Tips for Proper Use

Abstract

The conventional guidewire techniques for chronic total occlusion (CTO) lesions might not have been developed without the presence of various guidewires innovated and manufactured by dedicated Japanese company. Major guidewire techniques include “drilling,” “penetrating,” and “sliding” techniques. Asahi Intecc has developed several concepts which can define the performance of each guidewire, including tip load, shaping ability and memory, tip flexibility, shaft support, torque transmission, slipping ability, trackability, and trap resistance. Guidewires such as Miracle series focused on drilling concept by improving torque transmission, whereas Conquest series was optimized for the lesion where penetration technique is necessary. Fielder, Fielder FC, and Fielder XT were innovated for the facilitating retrograde approach by providing very lubriciousness and high torque controllability. Recently developed Gaia series (especially in Gaia third) wires focused on the concept of deflection and rotation (directional torque) which is a unique feature as compared with contemporary GWs (e.g., Conquest Pro) for penetration. The milestones of CTO guidewire development are summarized in Table 6.1.