Abstract
Aim: The aim of this observational study was to evaluate the Silverway guidewire [Asahi Intecc Co.] that is designed to guide catheters during cardiac catheterization towards the aortic valve when the standard J-tip guidewire fails because of anatomical anomalies. Materials and Methods: A total of 50 consecutive patients, in which the Silverway guidewire was used, were analyzed: procedural characteristics, such as anatomical challenges, crossing of the vessel and deliverability of the catheters were prospectively collected. This sample size was considered reasonable to describe the success, because this was the first observational study on the performance of the Silverway guidewire. Results: In the majority of procedures, transradial access was used (47 cases; 94%). The Silverway guidewire was able to cross the vessel in 98% and to deliver catheters in 92% of patients. Most anatomical challenges occurred at the radial artery level (39 cases). No clinical important complications occurred after use of the Silverway guidewire. Conclusion:The Silverway guidewire is highly successful in overcoming anatomical obstacles without vascular complications during cardiac catheterization when the J-tip guidewire fails to cross the vascular anatomy.
Highlights
[4] When tortuosity or spasm is present, the operator can switch to a hydrophilic guidewire (Polymer wire). [6,7] This is a Nitinol guidewire covered with a hydrophilic polymer coating
A total of 50 patients underwent a cardiac catheterization with the use of a Silverway guidewire between July 2021 and November 2021
In 5 patients (10%) the left radial approach was used at start and in 3 patients (6%) an initial femoral access was obtained
Summary
[1] Compared with the femoral approach, radial access has significant reduction in mortality, major bleeding complications, major adverse cardiac events (MACE) and vascular complications, and lowers mortality in patients with ST-segment elevation myocardial infarction (STEMI). Once radial access is obtained, a regular J-tip guidewire (Spring wire) is advanced towards the aortic valve followed by a diagnostic or guiding catheter. [6,7] This is a Nitinol guidewire covered with a hydrophilic polymer coating. It has higher lubricity for better vessel access and lesion crossing. Challenges encountered with a Polymer wire are low torque transmission and less support compared to a Spring wire because of the Nitinol core. The high lubricity might cause easier entry into side branches and can cause a dissection or perforation. [5,8,9]
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