Experience with a New Workhorse Guidewire

Joseph De Gregorio, MD, Chief of Interventional Cardiology and Interventional Research, Hackensack University Medical Center, Hackensack, New Jersey Can you tell us about the cath lab at Hackensack University Medical Center? De Gregorio: Hackensack is the fourth-largest medical center in the country and one of the top fifty rated cardiac centers in the U.S. We perform over 3,000 coronary interventions a year along with a significant number of peripheral procedures. Tell us about your experience with the Runthrough NS (nitinol stainless) guidewire. De Gregorio: I have been using it for the past few months and have been able to evaluate it extensively in some complex cases. I like its deliverability and torqueability. To me, the wire’s greatest asset is that it is not only very deliverable but that it also provides good support. There are cases where you might have to use a soft hydrophilic wire to reach a difficult area, but the tradeoff is that the wire may not provide the support you need to deliver your devices. You may end up having to switch out for a wire that gives you that support. With the Runthrough, having to switch wires may happen less frequently. What have you seen happening with the development of guidewire technology? De Gregorio: For quite some time, there was not much happening in regards to guidewire innovations and new technology. A few years ago, we got the Asahi wires from Japan, which now come to us through Abbott. The Asahi wires were a breakthrough, but the advantages were mostly in the realm of total occlusions. There hasn’t been anything really innovative on the market for a general workhorse wire in a very long time. Can you share a recent case with us where you have used the Runthrough?> De Gregorio: I have used it in some difficult situations. The one case in particular that comes to mind is one where I had to access a posterior lateral branch of the right coronary artery through a vein graft which was attached to the right posterior descending artery (PDA). What I needed to do was access the saphenous vein graft with a multipurpose guide and wire down to the PDA where it connected. I then had to retrogradely go up the PDA, around the point where it bifurcates in the distal RCA with the posterior lateral branch, and put the wire in the distal posterior lateral branch. I had to treat the area of the takeoff of the posterior lateral branch at the bifurcation, so I had to deliver balloons and subsequently a stent to that area. The wire performed very well. I was surprised at how easily I was able to deliver it to that segment of artery, and that it actually gave very good support in being able to maneuver devices to that segment. Have you noticed any time savings from not having to change out wires? De Gregorio: Yes, absolutely. That’s part of what makes this a favorable wire. As I noted, one of the things we have had to do in the past to access difficult areas is go in with a less supportive wire, and then switch it out to a different wire so we have the necessary support. With the Runthrough, however, it has been easier to deliver devices to a difficult area without always having to add a second wire or switch out for a stiffer wire. We can then work safely over the original wire, because it usually gives adequate support. Since this is a general workhorse wire, how does it affect your use of specialty wires? De Gregorio: Specialty wires are for the more complex and difficult cases such as total occlusions and maybe other areas that are very tortuous or calcified. You will always need specialty wires. With the current workhorse wires, you may have to delve more often into certain specialty wires, whereas with the Runthrough, it will happen less often. Dr. De Gregorio can be contacted at: jdegregorio@humed.com Charlie Baker, Jr., RT, Hackensack University Medical Center Hackensack, New Jersey Can you tell us about the staff mix at your lab? Baker, Jr.: We have 6 labs here at Hackensack and do anything from diagnostic and interventional coronary to, to cerebral and all other sorts of peripheral procedures and interventions, as well as IVC filters. We have 9 CVT/RTs, 16 RNs and 12 monitor techs. Each profession has their own set job descriptions. There is some crossing over, but for the most part, the monitor techs are pretty much always behind the monitor, doing patient hemodynamics as well as billing forms, whereas the nurses are dealing with patient needs, medications and charting, while the CVT/RT is working at the table with the physician. How much do physicians rely on your expertise and knowledge? Baker, Jr.: We are right there by their side, so a lot of physicians look to us as their assistant, so to speak, to recommend or suggest anything. Remember, we are the ones involved with thousands of these procedures, as opposed to the physicians, most of whom perhaps do a couple hundred procedures a year. We are better able to keep up with new products and technology. Occasionally we have a physician that has only two cases in a week. A lot can happen in a week with new technology, so we keep them up to date. I would say most of them really do look forward to our suggestions, especially in a tight situation. What are some of the new devices and products that you are seeing in your lab lately? Baker, Jr.: Lately, a lot of the new technology has been in the peripheral world because the peripheral procedures are becoming more and more popular, in our lab especially. I have been at Hackensack a little over two and a half years, and just in that time, the peripheral work has more than doubled. We are seeing anything from new kinds of peripheral stents to new wires and sheaths. For coronary work, you’re trialing the Runthrough NS wire. How are you finding it? Baker, Jr.: For the most part, the coronary guidewires have all been sort of comparable. There are the specialty wires and there are the typical workhorse type of wires such as the BMW. So when we first received the Runthrough wire, we figured that it would be another specialty wire that we will use once or twice a week for special situations. But it has proven to be the exact opposite. This wire can be your workhorse wire and can also serve as your specialty wire. It has multiple capabilities, based on what I have seen in several dozen cases. What conclusions have you drawn? Baker, Jr.: The Runthrough is very durable. Some of the wire tips, when you are trying to get across a tortuous vessel or a tight blockage, tend to get a little banged up and not work as well, whereas we have yet to see that happen to the Runthrough wire in the different types of lesions we have tried. So far it’s the most durable wire I’ve ever come across. Also, every time you have to change a wire, it’s an additional cost. If you can just use one wire for the entire case, that’s obviously going to cut back on costs and the need to use multiple wires on a single-vessel type of case. It’s a little shocking to think about. Where has this technology been? The fact that this wire is shapeable and crosses lesions with ease, and when you’re finished with the procedure and take the wire out, it looks exactly the same as when you put it in is just phenomenal. Many of the wires, when you take them out at the procedure end or if the wire won’t work, have a completely beat up and mangled tip. In these cases, you have to use another wire, or even a second or third wire after that. With the Runthrough, we seem to have only needed one. Charlie Baker, Jr. can be contacted at charlesbaker@humed.com