Minimizing Guidewire Unwilling Passage and Related Perforation During Transradial Procedures: Prevention Is Better
Lili Xu1,2, Jiatian Cao1,2, Meng Zhang3
1Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
Insights
A novel knuckle guidewire significantly reduces guidewire passage issues and perforation during transradial coronary angiography. This improved efficiency and patient safety compared to traditional guidewires.
Area of Science:
- Cardiovascular Interventions
- Medical Device Innovation
- Interventional Cardiology
Background:
- Transradial coronary angiography traditionally uses guidewires with passage difficulties and risk of branch injury.
- Existing guidewire methods present challenges in navigating complex coronary anatomy.
- Need for improved guidewire technology in transradial procedures.
Purpose of the Study:
- To evaluate the safety and efficiency of a novel active knuckle-angle 0.035-inch hydrophilic guidewire.
- To compare the knuckle guidewire against traditional unmodified guidewires in transradial coronary angiography.
- To assess the reduction in procedural complications and time.
Main Methods:
- Retrospective analysis of 1,457 patients (Traditional group) vs. 1,322 patients (Knuckle group) from August 2015 to June 2020.
- Randomized controlled study of 239 patients comparing unmodified and knuckle guidewires.
- Data collected on guidewire passage, complications, and procedure duration.
Main Results:
- Unwilling guidewire passage into branches was significantly lower in the Knuckle group (0.08%) vs. Traditional group (9.5%) in retrospective analysis (p < 0.001).
- Guidewire-associated perforation occurred in 2 patients in the Traditional group, none in the Knuckle group.
- Randomized study showed reduced unwilling passage (1% vs. 10.8%) and decreased guidewire advancement time (21s vs. 33s) with the knuckle guidewire.
Conclusions:
- The active knuckle-angle guidewire is a novel method to prevent unwilling passage and associated perforations.
- This guidewire improves procedural efficiency and potentially reduces radiation exposure.
- The knuckle guidewire offers enhanced safety and efficacy in transradial coronary angiography.
Background:
Current guidewires for transradial coronary angiography had defects of passage difficulty or branch injury. This study sought to investigate the safety and efficiency of a novel method of active knuckle-angle 0.035-inch hydrophilic guidewire in transradial coronary angiography.
Methods:
Patients undergoing a transradial coronary procedure in our team from August 2015 to June 2020 were retrospectively investigated. We compared the demographic and interventional characteristics of 1,457 patients receiving advancement of unmodified guidewires (Traditional group) and 1,322 patients receiving advancement of the knuckle guidewire (Knuckle group). Afterwards we included 239 patients and randomized them according to a random number table to either the unmodified or the knuckle guidewire to further confirm the efficiency and safety of knuckle guidewire advancement.
Results:
In the retrospective analysis, unwilling passage of guidewire into branches occurred more in the Traditional group than in the Knuckle group (9.5 vs. 0.08%, p < 0.001). Two patients in the Traditional group experienced guidewire-associated perforation. One patient was treated with covered stent for internal mammarian artery perforation, while the other was managed with compression for brachial branch perforation. In the randomized controlled study, unwilling passage of guidewire also occurred more in the Traditional group (10.8 vs. 1%, p < 0.001). Median duration of guidewire advancement from the sheath to aortic root significantly decreased from 33 seconds in the Traditional group to 21 seconds in the Knuckle group.
Conclusion:
Active knuckle angle guidewire represented a novel method to prevent unwilling passage and associated perforation with efficiency improvement and a reduction in radiation exposure.
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