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Abstract
Guidewires provide the primary interface between percutaneous coronary intervention operators and the coronary arteries. As percutaneous coronary intervention complexity has increased, new design elements have been developed to enhance wire performance. The emergence of advanced techniques for chronic total occlusions has been enabled by advanced wire design and has driven design innovation. This article categorically describes the design elements used in contemporary coronary guidewires, then outlines the elements that are combined to create wires intended for specific purposes. Functionally-defined categories of chronic total occlusion guidewire use provide a framework for discussing wires optimized for lesion access, collateral crossing, directed penetration, traversing microchannels, subintimal tracking (knuckling), re-entry and externalization. A task-specific approach to wire selection and inventory is advocated.
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