ABSTRACT
The intrinsic capacity of a guidewire to cross a chronic coronary occlusion is dictated by its ‘steerability’ (the wire tip response to subtle torque movements), pushability (or wire tip stiffness) and ‘crossability’ (the interaction of the wire material with the occluding tissue). In the current decade, we have seen the clinical introduction of various dedicated guidewires and guidewire systems. Within the multitude of available chronic total occlusion wires, the following three major subgroups can be defined:
1. Active guidewires or guidewire systems. Examples are the laser guidewire (Spectranetics, CO, USA)19 and the activated guidewire,20 which were especially designed to cross lesions refractory to conventional guidewires. The results of several registries have suggested an advantage of the laser guidewire and the activated guidewire over conventional guidewires.21,22 However, this advantage was not sustained in a recently performed randomized trial.23 The most recent technical development in this category is the Safe-Steer TO Crossing System (IntraLuminal Therapeutics, Carlsbad, CA, USA). This system gives on-line spectroscopic information as acquired from the tip of the guidewire. As the spectroscopic signals from plaque and normal adventitia are distinctively different, this spectroscopic signal can be used for guidance of the guidewire through an occluded segment.
