ABSTRACT
Chronic total occlusion (CTO) remains one of the most difficult challenges for the interventional cardiologist. This chapter focuses on guidewire technology and the appropriate selection of wires for different subsets of chronic occlusions. Guidewires can be classified into several dichotomous categories: hydrophilic vs hydrophobic, stiff vs soft, supportive vs non-supportive, and tapered vs non-tapered. Hydrophilic guidewires have special coatings engineered from absorbent materials, which become slippery upon contact with liquids, such as saline or blood. Stiff guidewires make up the remainder of the coronary guidewires for approaching CTOs. These wires have a standard, non-hydrophilic coil tip designed to facilitate the penetration of either the proximal or distal cap, especially when the cap is fibrotic and hard. Chronic total occlusions represent one of the most difficult procedural challenges for interventional cardiologists. Hydrophilic guidewires have been compared with conventional wires in small series of coronary intervention procedures.
