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Use of a New Guidewire: The Tigerwire
Under the directorship of Samin K. Sharma, MD, FACC, the cardiac catheterization laboratory at Mount Sinai Hospital performed 4,908 interventions in 2007, out of which 400 endovascular interventions were done. The total catheterization volume was >14,500. The catheterization laboratory has 4.5 rooms with 5 full-time interventionalists and 8 part-time interventionalists. The cath lab staff has grown over the last five years, with the current number of employees being over 125 (46 nurses and 8 nurse practitioners).
I perform all types of endovascular interventions, including renal artery, superficial femoral artery, tibial artery, and subclavian artery interventions. All procedures are performed in one room, which functions as both a coronary room and peripheral room.
How long have you been using the Tigerwire?
I have been using the Tigerwire for a few months and have done approximately 100 cases with the wire.
Is it a specialty wire or a general workhorse wire?
The Tigerwire can function as both. It can be a workhorse wire because it has a safe tip with a stiff body and therefore can be used in most applications in the cath lab. Its unique feature of a gradual transition between a flexible tip to a stiff body makes it ideal to use as a specialty/workhorse wire in endovascular interventions. For example, this gradual transition of the wire enables a rapid iliac cross while working from the contra lateral approach. The stiff body provides ample support to track a sheath and deliver devices to the lesion. The soft tip and gradual transition zone provides safety against dissections or perforations while working on difficult lesions in the superficial femoral artery. Another advantage is the shapeable tip and torquability of this wire. This enables the operator to negotiate the external/internal iliac bifurcation and steer the wire across lesions. These are significant advantages and provide the endovascular specialist with a powerful tool to get the job done.
Can you share more about the Tigerwire design?
The Tigerwire is a stainless steel, single core wire. The features that distinguish it from other 0.035 wires are its flexible tip and torquability with a stiff body. These features combine to make this wire a safe and effective tool in endovascular interventions.
How does the Tigerwire compare to other available wires?
The common wires used are the Wholey Wire, Angle Terumo, Magic Torque, and Zip Wire. All of these wires have application in peripheral intervention. The Tigerwire is a combination of the strengths of each wire. The tip is forgiving like a Wholey wire. The body has adequate stiffness. The torquability is comparable to the Angle Terumo and Zip Wires. It is not hydrophylic, so it is less prone to cause dissections. The transition zone enables the wire to traverse extreme angulations and the shapeable tip allows navigation through complex lesions.
What about use of the wire for coronary procedures?
The Tigerwire can be used in coronary procedures to deliver catheters and guides.
Can you comment further on the timesavings you have experienced?
Yes. In my opinion, the Tigerwire should be the first wire tried due to its features as described earlier. More than likely, it will be the only wire needed for superficial femoral artery (SFA) and iliac procedures.
Any advice for labs that may be considering this wire?
All labs should have the Tigerwire on the shelf. Its design features make it an essential wire.
The Tigerwire is available from St. Jude Medical (www.sjm.com).
Dr. Krishnan can be contacted at prakash.krishnan@msnyuhealth.org
