Reviews of the Terumo Glidewire Advantage | Which Medical Device

Design/construction

The Terumo Glidewire Advantage is a combination wire consisting of a distal 25cm hydrophilic component fused with a stiff proximal shaft with spiral PTFE coating (fig 1 - © 2008, Terumo Medical Corporation. All Rights Reserved). The distal 5cm of the wire is tapered with an angled tip. The two wire sections are fused together using Terumo’s DuoCore Technology, which allows one to one torque transfer. The wire is 0.035” diameter and is available in two lengths, 180cm and 260cm.

Device in use

We highlight the uses and benefits of the Glidewire Advantage wire with a number of recent cases.

Case 1: A patient with gastric outlet and biliary obstruction secondary to inoperable pancreatic cancer underwent a combined stenting procedure. An external biliary drain and NG tube were already in place. The proximal duodenal obstruction could not be crossed with a traditional Terumo Glidewire. Using the additional stiffness and pushability of the Advantage it was possible to navigate through the stricture with the distal hydrophilic section (Fig 2). In this case, the length of the duodenal stent delivery device necessitated exchanging the Advantage for a JAG wire to allow stent placement (Fig 3). The next day the patient returned for a check cholangiogram to ensure patency of the biliary stent. An internal/external drain had been left in place. The Advantage wire was used to navigate the side holes of this drain (Fig 4). The drain was then exchanged for a 7F sheath over the Advantage and balloon dilatation of the stent performed over the wire (Fig 5).

Case 2: Combined endoscopic and radiological colonic stent insertion on a patient with a malignant sigmoid stricture. The colonoscope was advanced to the distal end of the sigmoid stricture and an Advantage guidewire was used to cross the stricture (Fig 6 ). A 12cm x 24mm Niti-S colonic stent was then deployed over the wire (Fig 7).

Case 3: Patient with bilateral VUJ obstruction secondary to prostate cancer. A left sided stent was already in place. A right sided lower pole calyceal puncture was performed and a 6F sheath inserted. An Advantage guidewire was used to cross the obstruction into the bladder (Fig 8), and a 22cm JJ stent deployed over the wire.

Results so far

These cases demonstrate the benefits of the Advantage wire. In the GI cases the additional proximal stiffness and resultant increased pushability of the Advantage wire enabled difficult distant strictures to be crossed. In all these cases the Advantage wire allowed the successful elimination of the exchange step, reducing procedure and screening time. In addition the use of a single wire has financial benefits – the cost of an Advantage wire is less than the combined price of a standard Terumo wire and, for example, an Amplatz.

The principal disadvantage we have encountered was being unable to cross lesions with the Advantage, which then required the use of a standard Terumo - thus resulting in increased procedure time and cost. Although the wire was principally developed for vascular cases, the majority of our usage has been in non-vascular cases.

Conclusion

The Advantage Glidewire is an excellent addition to any IR departments’ shelf. In appropriate cases it allows for elimination of the exchange step with the obvious benefits to both patient and interventional radiologist. The added stiffness and pushability provides a useful option for crossing difficult strictures, particularly in GI cases. Case selection is important as the wire is not suitable for all procedures and incorrect selection will result in increased cost and procedure time. With continuing experience using the wire it will become clear which cases are suitable and undoubtedly more applications for its use will become apparent. A 0.018” version of the wire is being released soon.