A new flexible and deflectable tip guidewire for coronary angioplasty and other invasive and interventional procedures.

’8Y A New Flexible and Deflectable Tip Guidewire For Coronary Angioplasty and Other Invasive and Interventional Procedures Richard K. Myler, MD,* Jonathan M. Tobis, MD,* David C. Cumberland, MD, Benito Hidalgo, RT In the past decade and a half, there has been a prodigious growth of coronary angioplasty. In large measure, this has occurred because of the evolution and development of angioplasty equip- ment. In the first coronary angioplasty era (1977- 79), the hardware was prototypal, thus limiting the procedure to patients having single vessel disease with stenoses (not occlusions) that were proximal, discrete, concentric and non—calcific that did not involve major side branches nor were located on angulated arterial segments}-5 In the second angioplasty era (1980-82), two From the San Francisco Heart Institute at Seton Medical Center, Daly City, California. *Hold equity positions in Pilot Cardiovascular Systems, Inc. Address for reprints: Richard K. Myler, MD, San Francisco Heart Institute at Seton Medical Center, 1900 Sullivan Avenue, Daly City, CA 94015. Vol. 4, No. 8, October 1992 technical advances occurred. The first was the guiding catheter which evolved from an unwieldy 9—10F solid Teflon model to a layered iteration with significantly improved memory and torque control. With the addition of numerous distal con- figurations, stable and coaxial cannulation of coro- nary arteries could be obtained.5 The second major advance was the development and introduction of a guidewire7z3 which permitted advancement through tortuous and branching arteries and across lesions with complex morphology and locat- ed in distal sites. Over the past decade, and in particular during the last 4 years, there have been further advance- ments in angioplasty technology1'5z9'12 with the development of smaller diameter guiding catheters13 and lower profile dilatation catheters, including monorail14«15 and balloon—on— a—wire16r17 devices with balloons that were thinner, more con- 393