A new guidewire technique for difficult cardiac catheterization.

PURPOSE: To propose a simple guidewire technique to resolve the problem of difficulty in advancing catheters or guidewires during vascular and cardiac catheterization. METHODS: A 0.035-inch J-tip guidewire was reshaped manually at the distal 7- to 8-cm portion, including the flexible part and 2-3 cm of the stiff part, into zigzag shape. With this modification, the guidewire became much more trackable and could be advanced to the right position. RESULTS: In the past 2 years, this 'zigzag wire technique' was applied in cardiac catheterization with high success rates for cases with difficulty in advancing either catheters or guidewires. This wire technique was applied in peripheral arterial tortuosity or stenosis (18 cases, with success in 17), aortic aneurysm (successful in all 7 cases), aortic stenosis (11 cases, successful in 8), and dilated right heart chambers (successful in all 6 cases). No complications resulted from the use of this guidewire technique. CONCLUSION: This simple method of guidewire modification would be very helpful in difficult vascular and cardiac catheterization when difficulty in advancing catheters or wires was encountered.

Retrograde wire-assisted percutaneous transcatheter closure of persistent ductus arteriosus with Amplatzer duct occluder in the elderly: A new application.

Percutaneous transcatheter closure of persistent ductus arteriosus (PDA) has been well established in the pediatric field. For moderate- to large-sized PDA, the newly developed Amplatzer duct occluder had offered a good solution, but it depends on stiff wire and delivery sheath. We reported two elderly patients of PDA with vascular anatomy too difficult to be antegradely approached and were closed by a retrograde technique by an assisting wire from the descending aorta. The wire served as a guide and tracked the delivery system to cross the ductus from the venous side smoothly. This retrograde wire-assisted technique could be utilized to overcome the PDA of difficult vascular anatomy, which could not be easily fulfilled by conventional antegrade venous approach.