Fragmentation of Hydrophilic Guidewire Coatings During Neuroendovascular Therapy

Purpose: Cerebral polymer coating embolism from intravascular devices may cause serious complications after endovascular therapy (EVT) for neurovascular diseases. Although polymer fragments are often created during endovascular procedures, exact mechanisms of their formation, especially if of small size, are largely unknown.

Methods: In this study eight microguidewires (Asahi Chikai 200 cm (Asahi Intecc, Aichi, Japan), Asahi Chikai Black (Asahi Intecc), Fathom™ (Boston Scientific, Marlborough, MA, USA), Hybrid (Balt Extrusion, Montmorency, France), Radifocus® Guide Wire GT (Terumo, Leuven, Belgium), Synchro® (Stryker, Kalamazoo, MI, USA), Transend™ EX (Boston Scientific), and Traxcess™ (MicroVention®, Tustin, CA, USA)) frequently used during EVT were investigated ex vivo using their dedicated metal or plastic insertion tools to assess for coating delamination after backloading of the microguidewires.

Results: Backloading caused damage to the coating of all microguidewires especially when the main body of the guidewires was bent in front of the insertion tool. All studied microguidewires produced microscopic filamentous and/or band-like coating fragments. Few larger irregular fragments were observed, but also very small fragments measuring 1-3 µm in diameter were found. Spectroscopic measurements of polymer fragments and microguidewires identified various polymers.

Conclusion: Backloading of polymer-coated microguidewires during EVT should be minimized if possible. More stable hydrophilic coatings on microguidewires and less traumatic insertion tools are desirable.