Microscopic Evidence Suggests Advantage for Polymer-Coated Wires at Bifurcation PCI

Patrice Wendling

May 23, 2016

PARIS, FRANCE — Under the microscope, polymer-coated (PC) guidewires are more resistant than non–polymer-coated wires to retrieval damage after jailing during coronary bifurcation, according to a randomized study[1].

"Jailed wires during interventional procedures of bifurcation lesions can have microscopic damage in around 28% of the procedures," principal investigator Dr Manuel Pan (Hospital Universitario Reina Sofia, Córdoba, Spain) said during a hot-line session at EuroPCR 2016.

The panel applauded the findings, including Dr Augusto Pichard (MedStar Washington Hospital Center, Washington, DC), who remarked that he always uses hydrophilic PC guidewires because they're much easier to cross, easy to remove, and mean less radiation for the patient.

"This was a beautiful demonstration with a microscope that indeed the polymer wire is much better than the traditional BMW [balance middleweight]-like wire. . . . It should change practice worldwide," he told heartwire from Medscape.

Pan said they postulated that jailed PC guidewires were more resistant to retrieval damage than traditional non-PC wires after a prior observational study. The jailed-wire technique, which involves keeping, or "jailing," the side-branch wire throughout the procedure to provide access should side-branch occlusion occur after main-branch stenting, is a useful strategy but requires some maneuvering to remove the wire.

For the present study, 235 patients with bifurcation lesions were randomized after angiography to PC or nonpolymeric guidewires during provisional stenting. Induced damage in the wires was evaluated by stereomicroscope and graded as mild (<2 mm), moderate (>2 mm), or severe (internal layer visible).

The most common bifurcation treated in both groups was at the left anterior descending artery. The average diameter and lesion length in the main vessel was 3.1 mm and 16 mm, respectively, and for the side branch 2.3 mm and 7 mm, respectively. Side-branch wiring was not possible in one patient in the PC arm and six in the non-PC arm.

In the PC arm, no damage was reported in 112 patients and mild damage in two. In the non-PC arm, 51 patients had no guidewire damage, 37 had mild, 24 moderate, and two severe damage, with no fractures occurring. The between-group difference was statistically significant (P=0.001), he said.

The wiring of the side branch was also significantly faster with PC wires than with non-PC wires (19 s vs 42 s; P=0.05).

Factors for wire damage were main vessel lesion length (15 mm no wire damage vs 18 mm moderate/severe damage; P=0.03) and jailed length of the wire (8 mm vs 11 mm: P=0.03). In multivariate analysis, jailed wire length remained statistically significant (odds ratio 1.15; P=0.02), Pan said.

Session cochair and EuroPCR course director Dr William Wijns (Cardiovascular Center Aaslt, Belgium) told heartwire that fellows have been taught for decades that hydrophilic wires should not be used for bifurcation or jailed because of concerns that the protein would peel off, but the data show exactly the opposite and that the polymer coating may actually be protective.

"Less damage, easier to cross the side branch, and a faster procedure; so it's a no-brainer based on this study." When asked whether another study is needed, "No, this seems pretty strong, two times 100 patients, randomized. You see how you can make big science from very practical [research]."

The study was sponsored by Maimónides Biomedical Research Institute of Córdoba and Instituto de Salud Carlos III. Pan reports minor lecture fees from Abbott.

Follow Patrice Wendling on Twitter: @pwendl. For more from theheart.org, follow us on Twitter and Facebook.

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