Magnum wire for balloon recanalization of chronic total coronary occlusions

Abstract

A new guidewire (Magnum wire, Schneider) was developed for balloon recanalization of chronic total coronary occlusions. This 0.021-inch solid-steel wire with a floppy tip equipped with a 1-mm diameter “olive” is used like an ordinary guidewire, fits conventional balloon catheters and provides excellent steerability. Magnum wires were used in 50 consecutive chronic total coronary occlusions (mean ± standard deviation duration 8 ± 21 months, range 1 day to 10 years; mean length 1.1 ± 0.8 cm, range 0.2 to 4.0). All occlusions were reached (in 23 right, 18 left anterior descending, 8 left circumflex coronary arteries and 1 diagonal branch) and 30 (60%) were recanalized (1 reoccluded during the procedure, and in 3 patients the Magnum wire did not completely cross the occlusion but enabled the previously impossible passage of a conventional wire). The mean age of the occlusion was 3 ± 4 months in successful and 17 ± 33 months in unsuccessful procedures (p = 0.04) and the mean length was 1.1 ± 0.9 and 1.3 ± 0.6 cm, respectively (p = 0.4). In 17 patients, conventional techniques had been exhausted before the Magnum wire attempt, which was successful in 8 (47%). In 33 patients the Magnum wire was tried first, with success in 22 (67%). Conventional techniques were subsequently tried in 9 of the 11 failures (none was successful). Of the 38 procedures carried out with a second, improved version of the Magnum wire, 26 (68%) were successful. In terms of complications, 2 distal clot embolizations, with a small creatine kinase increase in 1, occurred during or secondary to Magnum wire manipulations, whereas 3 proximal dissections with side branch occlusion in 2 (1 with a small creatine kinase increase) occurred during or secondary to attempts with conventional wires. The Magnum wire is a simple, safe and inexpensive tool for balloon recanalization of chronic total coronary occlusions. It is subject to the basic limitations of conventional wires (duration and length of the occlusion, subintimal passage) but yields a slightly higher success rate, probably due to superior pushing power and a more blunt approach that reduces the risk of subintimal passage. Evaluation of the Magnum wire for coronary lesions other than total occlusions is under way.