Optimal Guide Catheter Support With Silverway



Nov. 18, 2021



Optimal Guide Catheter Support With Silverway

Recording 1 Fluorscopy imaging showing that with the correct technique, the radial loop can be crossed, after failing in the first attempt


The ASAHI Silverway is a high performance angiographic guide wire based on the 0.035” platform. A typical characteristic is the high trackability of the wire to negotiate and cross complex arterial architecture. This high trackability comes from the flexible Silverway tip that accurately follows the path line of the arteries. A logical consequence is that specific tip part of Silverway provides less support for the guide catheter(GC) in use.

The distal flexibility of Silverway should not be perceived as a trade-off, having lower support provided to the GC. The user only needs to apply a simple wiring approach to benefit from the high trackability and have the superior support for the GC. To benefit from the flexibility as well having high support, the user must reassure that Silverway is placed or used in such a way, that the high supportive part is positioned in the GC.

To utilize the high supportive part of Silverway for an effective movement of the guiding catheter, Silverway must be pushed far enough out of the GC tip. With this strategy the flexible tip is in front of the GC, and the high supportive part is in the lumen of the GC. This will lead to an optimal straightening of the GC curve, and the highest support to guide the GC trough complex arterial anatomy.

The technical explanation for this wiring approach is that the first 15 cm of the Silverway tip is made highly flexible for high performance tracking trough arteries. Thus, beyond this point the rigid and supportive part starts of the guide wire shaft. Meaning in practice that for having the highest support for the GC, it must be placed at least 15 cm from the tip.

Figure 1 Starting point in radial artery loop
Figure 2 Flexible tip Silverway in loop: pushing GC through loop failed


Recording 1 is a fluoroscopy recording of a guide catheter and  Silverway set up that is attempted to cross a radial arterial loop. This recording perfectly shows the difference in crossing success between using the high(shaft) or the low(tip) supportive part of Silverway.

Figure 3 Pushing GC: Radial loop size grows as GC cannot progress

In figure 1, a screenshot of the begin part recording 1, we can see Silverway cannulated in a GC, both traversing a radial arterial loop. In this situation the flexible tip of Silverway is still partially in the GC tip and the radial loop. Due this position, the set up has too little support provided by Silverway for crossing the radial loop. Figure 2 and 3 are showing the effect when the GC is tried to be moved forward; the radial loop’s radius increase as the GC cannot track forward due to little support. We can even see the effect of continuous pushing with too little support in figure 4, under the applied push force the radial loop tilts.

Figure 4 Push GC: Loop tilts by push force / still too little support at this time

Figure 5 and 6 are elegantly showing what happens when the supportive part of Silverway is placed at the tip of the GC, thus positioning the flexible tip in front of the GC. As result of the optimal placement of Silverway, the GC could successfully cross the radial arterial loop.

Figure 5 Silverway forwarded: high support part is in the loop area
Figure 6 High support shaft Silverway in loop: GC can cross

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