Safety of hydrophilic guidewires used for side-branch protection during stenting and proximal optimization technique in coronary bifurcation lesions Arka Chatterjee a , Brigitta C. Brott a, c , Robin Foley b , Oluseun Alli a , Mark Sasse a , Mustafa Ahmed a , Firas Al Solaiman a , Gautam Reddy a , Sameer Ather a , Massoud A. Leesar a, ⁎ a Division of Cardiology, University of Alabama-Birmingham, USA b Department of Material Science and Engineering, University of Alabama-Birmingham, USA c Department of Biomedical Engineering, University of Alabama-Birmingham, USA abstract article info Article history: Received 11 December 2015 Received in revised form 7 April 2016 Accepted 19 April 2016 Available online xxxx Keywords: Coronary bifurcation lesions Hydrophilic guidewire Polymer shearing Proximal optimization Background and propose: In coronary bifurcation lesions (CBL), hydrophilic guidewires used for side-branch (SB) protection can be withdrawn from underneath the stent easier than other wires. However, the safety of which has not been investigated. Methods/materials: We performed scanning electron microscopic (SEM) examination of hydrophilic wires – the Whisper and Runthrough wires – used for SB protection during stenting and proximal optimization technique (POT) in 30 patients with CBL. The distal 15 cm of the wire was examined every 1 mm by SEM and 4500 segments were analyzed to investigate for wire fracture, polymer shearing (PS), and its correlations with post-stenting cre- atine kinase (CK)-MB release. Results: SEM examination showed no evidence for wire fracture. The total area of PS and the largest defect on the wire were significantly larger with the Whisper wire versus the Runthrough wire (0.15 ± 0.04 mm 2 vs. 0.026 ± 0.01 mm 2 and 0.04 ± 0.05 mm 2 vs. 0.01 ± 0.01 mm 2 ;P b 0.05, respectively). The total length of PS and the lon- gest defect on the wire were significantly longer with the Whisper wire vs. the Runthrough wire (12.1 ± 14.5 mm vs. 2.7 ± 3.0 mm and 2.9 ± 4.2 mm vs. 1.0 ± 1.2 mm; P b 0.05, respectively), but there were weak cor- relations between the extents of PS with CK-MB release. Conclusions: Hydrophilic guidewires may be safely used for SB protection during stenting and POT in CBLs. The extent of PS was significantly greater with the Whisper wire than with the Runthrough wire, but its correlation with post-stenting CK-MB release was weak. © 2016 Elsevier Inc. All rights reserved. 1. Introduction Coronary bifurcation lesions (CBL) are challenging and associated with a higher rate of adverse events than non-bifurcation lesions [1]. In the era of drug-eluting stents, 2 primary interventional strategies for treating CBL include the complex strategy – main vessel (MV) and side-branch (SB) stenting, and the simple strategy – MV stenting with provisional SB stenting. Since the complex strategy is associated with increased event rates, the simple strategy with provisional SB stenting is now the preferred approach [2–4]. In the simple strategy, a guidewire is frequently inserted into the side-branch (SB) to prevent acute SB occlusion during main vessel (MV) stenting. This is known as the “jailed wire technique”. It has been shown that SB compromise is not inconsequential and is associat- ed with a greater risk of myocardial infarction or cardiac death [5–7]. Hydrophilic guidewires can be withdrawn from underneath the stent struts easier than other wires. However, there are concerns that wire fracture or polymer shearing (PS) can occur during the withdrawal of hydrophilic wires, which may lead to myocardial infarction. However, data on the incidence of wire fracture with the jailed wire technique are scant. A number of case reports demonstrated the fracture of non- hydrophilic guidewires used as the jailed wire technique during MV stenting [8–11]. One case report showed evidence for polymer damage to a hydrophilic wire jailed in the SB [12]. The sheared and embolized polymers have been detected inside the small intramyocardial arteries in biopsy specimens, but the link between PS and myocardial infarction (MI) could not be ascertained [13]. Thus far, no study investigated the safety of hydrophilic wires used as the jailed wire during stenting and proximal optimization technique (POT) in CBLs. Therefore, we investigated the rate of wire fracture and Cardiovascular Revascularization Medicine xxx (2016) xxx–xxx Abbreviations: CBL, coronary bifurcation lesions; MV, main vessel; POT, proximal optimiza- tion technique; SEM, scanning electron microscopic; SB, side-branch. ⁎ Corresponding author at: University of Alabama-Birmingham, UAB Heart and Vascu- lar Center, 510 20th Street South, FOT: 920, Birmingham, AL 35294, USA. E-mail address: mleesar@uab.edu (M.A. Leesar). http://dx.doi.org/10.1016/j.carrev.2016.04.006 1553-8389/© 2016 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Cardiovascular Revascularization Medicine Please cite this article as: Chatterjee A, et al, Safety of hydrophilic guidewires used for side-branch protection during stenting and proximal opti- mization technique in coronary b..., Cardiovasc Revasc Med (2016), http://dx.doi.org/10.1016/j.carrev.2016.04.006