The Steerable Guidewire: A Simple Method to Recross Deployed Stents

Recrossing a deployed stent with a guidewire is sometimes required when a distal lesion is recognized after wire withdrawal, or when a second “buddy wire” is required to facilitate distal advancement of another device. A popular technique is to create a large exaggerated loop on the distal wire tip to avoid passage beneath struts. Difficulty, however, can be encountered in steering such a curve through the proximal vessel, especially if the stent is placed distally in a tortuous artery. We have found the new Steer-It wire (Cordis Corp., Miami, Florida) to be immensely useful in such situations. Designed to negotiate tortuous coronary anatomies, it is a 0.014-inch diameter wire consisting of a thin filament affixed at its distal tip to that of a hypotube in which it is housed. A sliding component of the proximal handle allows the operator to variably deflect the curvature of the distal end in vivo. After exit from the guiding catheter, the wire tip is constantly modified as needed to access and navigate the coronary system before the stent. At the proximal edge of the stent, the curvature is then maximized to > 90 degrees, and the wire is advanced through the stent. The knuckle formed while crossing the stent prevents substrut passage. Thereafter, the tip is relaxed again to suit the tortuosity of the distal vasculature. This technique is likewise useful when a second “buddy wire” is required to facilitate passage of a device either into the stent, such as a post-dilatation balloon, or beyond it, such as a subsequent distal stent. In the majority of cases, the shaft support was adequate to allow distal stent delivery. With the increasing deployment of stents into less favorable anatomies comes the inevitable need at times to reaccess them. The Steer-It wire offers a simple, user-friendly solution to this problem.