A prospective, randomized comparison of workhorse guidewires for bifurcation percutaneous coronary intervention.

Background: Despite the significant improvement in guidewire technology, in-vivo comparison of workhorse guidewires is lacking. This study aims to assess the feasibility of randomized data collection regarding the wiring time and its variability among three guidewires: Sion Blue, Minamo, and Runthrough, and to identify key lesion characteristics for future guidewire research.

Methods: 45 patients were randomized between February of 2023 and May 2024. Patients undergoing elective percutaneous coronary intervention (PCI) to a bifurcation lesion requiring two guidewires were included. The wiring time was defined from when the tip of the guidewire at the end of the guide catheter until the advancement to the distal target vessel.

Results: The mean wiring time was 55.3 seconds for side branch and 95.8 seconds for main branch. The wiring time was similar for both side-branch wiring (Sion Blue 65.9±79.5, Minamo 41.2±33.4, Runthrough 57.6±88, P=0.65) and the main branch wiring (Sion Blue 44.8±38.9, Minamo 123.8±189.4, Runthrough 119.1±183.6, P=0.3). Use of the torque device, guidewire reshaping, or switching to a second guidewire were uncommon. Lesions requiring longer wiring time had severe stenosis (>90%), severe calcification, or tortuosity. The median crossing time was longer when recrossing stent struts, especially during two-stent strategy (>130 seconds).

Conclusions: Prospective data collection assessing the difference of wiring time as a clinical endpoint is feasible. Our study results can form a basis for future studies comparing different guidewires.