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Zivelonghi et al. Vessel Plus 2019;3:30 I http://dx.doi.org/10.20517/2574-1209.2019.06 Page 5 of 11

2. Lesion length: lesions are divided in less versus more than 20 mm. Lesions ≥ 20 mm have a longer
[12]
procedure time and lower success rate using standard wire escalation techniques . In this case the best
primary approach may be dissection reentry techniques.

3. Target coronary vessel at the distal cap: this refers to the size of the lumen after the distal CTO cap,
distally to the lesion itself, and the eventual presence of significantly visible side branches at the distal cap
level; this characteristic has also an impact on the possibility to perform dissection/re-entry techniques.

4. Size and suitability of collateral circulation for retrograde techniques (so called “interventional
collaterals”): optimal collateral vessels can be easily accessed with wires and microcatheters, are large
[6]
enough to allow the passage of these devices, have minimal tortuosity and are not the only source of flow .

DEVICES TO SUPPORT PCI
Wires
1. A hydrophilic and/or polymer-jacket 0.014” guidewire, low-gram force with tapered tip for outweigh
microchannel or soft tissue, for collateral channel passage and for knuckle techniques (examples: Fielder
XT, Fielder XT-A, Fielder XT-R, all Asahi Intecc, Nagoya Japan).

2. A non-tapered, polymer-jacket hydrophilic 0.014” guidewire for collateral channel crossing in retrograde
approach. (examples: Fielder FC, Suoh 03, Sion black, all Asahi Intecc, and Pilot 50, Abbott Vascular Santa
Clara, California).

3. A moderately high gram force (from 4 to 6 g) polymer-jacket non-tapered guidewire for complex lesion
crossing, knuckle technique and dissection re-entry, such as Pilot 200 (Abbott vascular) guidewire.

4. A high-gram-force 0.014” guidewire with a tapered non-jacketed tip for penetration techniques, cap
puncture, complex lesions crossing and lumen re-entry techniques, for example Miracle 12, Confianza Pro
12 wire (Asahi Intecc) or Hornet 14 (Boston Scientific).

Microcatheters
1. Corsair (Asahi Intecc): it’s a 2.7 F microcatheter. It is originally designed for septal collateral crossing.
The length for this use is 150 cm. Thanks to the screw like structure of the distal part, which uses 2 thick
stainless-steel wires and 8 thin stainless-steel wires, it ensures very high crossability into tortuous vessels
during retrograde approach. It reinforces the torque transmission to the guide wire and creates better
backup for penetration of harder lesions. An antegrade version to support antegrade techniques (wire
support and exchange) has been developed with a length of 135 cm. Both the 5 mm tapered soft tip with
Tungsten powder mix and the reinforced tapered shaft after the screw like structure, are coated with a
Hydrophilic Polymer, which provides lubricity and enhances maneuverability. It also allows super selective
injection of contrast.

2. Caravel (Ashai): the lengths are 135 cm (for antegrade approach) and 150 cm (for retrograde approach),
the tip entry profile is 0.48 mm and the microcatheter is coated with hydrophilic coating. It is compatible
with 0.014” wire. It has good crossing profile and trackability and the low-profile shaft facilitates the
crossing of microchannels.

3. Turnpike (Teleflex): it’s a “family” of microcatheters containing a robust multi-layer shaft that provides
enhanced flexibility, torque and tracking over a 0.014” guidewire. There are: the Turnpike (antegrade version
135 cm, retrograde 150 cm), the Tunpike Low Profile (LP, antegrade version 135 cm, retrograde 150 cm), the
Turnpike Spiral (only antegrade 135 cm) and the Turnpike Gold (only antegrade 135 cm).