The effects of types of guidewires and pressure applied during stent implantation in the main vessel on the incidence of damage to coronary guidewires during angioplasty of coronary bifurcation lesions—Wide Beast study


OBJECTIVES: We evaluated the impact of stent inflation pressure and type of guidewire on “jailed” coronary guidewire damage occurring during bifurcation angioplasty.

BACKGROUND: Despite new techniques and treatment options during percutaneous coronary intervention (PCI) we still observe peri‐ and postoperative complications for to various known and unknown reasons.

METHOD: Patients undergoing PCI within the coronary bifurcation were randomly assigned to one of four groups: Pilot 50 or BMW guidewire and pressure ≤12 or >12 atm. After PCI each “jailed” guidewire was evaluated under an optical microscope. The Wide Beast Scale (WBS) was developed for the internal purposes of the study and was used for qualitative assessment. Also, the inflation pressure, the patients’ characteristics and the technical parameters of the procedure were recorded.

RESULTS: The clinical characteristics were similar in all the groups. There was no statistical significance of the degree of damage, rated on the WBS, for either guidewire group with respect to inflation pressure (P = 0.49). The prevalence of guidewire damage was higher in the BMW versus the Pilot 50 group (98.4% vs 67.4% respectively, P = 0.00001) as was the severity of the damage (grades 3 and 4) in BMW versus Pilot 50 (55.6% vs 13.0% respectively, P = 0.00001).

CONCLUSION: The inflation pressure during stent implantation had no impact on “jailed” guidewire damage. The difference in the prevalence of serious damage and total damage number was statistically significant for the BMW guidewire compared to the Pilot50. The BMW guidewire was an independent predictor of the degree of damage to the guidewire.

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Kwiatkowski PS, Malachowski J, Jakubas‐Kwiatkowska W, et al. J Interv Cardiol 2018;31:599–607.