In this episode, host Ally Baheti interviews interventional cardiologist Dr. Hady Lichaa of Ascension St. Thomas Heart about wire senses, including ways to build tactile and visual skills, selection of workhorse and specialty wires, and the do’s and don’ts of crossing lesions.

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SHOW NOTES

Dr. Lichaa starts by outlining four different components of wire senses: visual sense, tactile sense, IVUS, and the digital subtraction angiography (DSA) roadmap. First, visual aspects are a combination of 2D wire sliding and looping, 3D rotation, and the course of the wire relative to the vessel architecture. By combining these visual cues, the operator can determine if the wire is inside the true lumen, within the vessel wall, or entirely outside of the vessel.

The next factor is tactile sense. Each type of wire strikes a balance between resistance to rotation / advancement and torque transmission. This balance is determined by wire characteristics such as core material, tapers, tip design, and coating. Dr. Lichaa encourages operators to test out different wires and focus on mastering their favorite workhorse wires. Additionally, there are specialty wires that can be employed in certain cases, such as CTO wires with heavy tip, tapered tip wires to enter microchannels, and supportive wires for the use of other equipment.

Additionally, we discuss how intravascular ultrasound (IVUS) leads to safer outcomes because it allows the operator to confirm that they are in the true lumen and measure vessel size before deploying stents or balloons. DSA can also help determine location and help map out different strategies if a first option fails.

Finally, Dr. Lichaa lists some helpful tips for new operators. We highlight the importance of mastering your favorite wires, having backup plans, communicating with staff, and keeping calm in the angio suite.

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RESOURCES

Abbott Command Wire:

https://www.cardiovascular.abbott/us/en/hcp/products/peripheral-intervention/guide-wires/workhorse/hi-torque-command.html

ASAHI Gladius Wire:

https://asahi-inteccusa-medical.com/product/asahi-gladius-014/

ASAHI CONFIANZA Pro:

https://asahi-inteccusa-medical.com/product/confianza-pro-series/

Terumo NAVICROSS Support Catheter:

https://www.terumois.com/products/catheters/navicross.html

Teleplex Turnpike Catheter:

https://www.teleflex.com/usa/en/product-areas/interventional/coronary-interventions/turnpike-catheters/index.html

ACT ONE Technology:

https://medical.asahi-intecc.com/en/technologies

Philips Pioneer Reentry Catheter:

https://www.usa.philips.com/healthcare/product/HCIGTDPPLUS/pioneer-plus-ivus-guided-re-entry-catheter

Cordis OUTBACK Reentry Catheter:

https://cordis.com/na/products/cross/endovascular/outback-elite-re-entry-catheter