Clinical Experience
Pressure guidewires have been proven through multiple studies to improve PCI outcomes, mostly by providing a better diagnosis on coronary disease. The idea to measure coronary physiology post stenting isn’t new but the previous technologies have been the main limitations to be able to perform measurements pre and post stenting.
In fact, with traditional pressure guidewires we usually don’t stent over them or when we do, we often can’t reconnect it with reliability to get a post-PCI pressure measurement. Those additional manipulations lead to the use of multiple adjunct devices, several exchanges which make the cases longer, more costly and sometimes more risky¹.
Some other challenges include the inability to manipulate the pressure guidewire like a workhorse guidewire, the loss of precision – or drift – during the case, and the need to use adenosine to have a larger window to make the proper decision (.80 cutoff) vs. adenosine-free indices which require perfect accuracy (cutoff .89).
When we started to use the OptoWire™, which has the Fidela™ sensor embedded, all those limitations went away thanks to the accuracy of this second-generation fiber optic sensor and the concentric design of the guidewire which provide workhorse-like performance. Additionally, the unique disconnect/reconnect feature now allows us to perform the entire case without the need for adjunct devices or exchanges. With this new technology, we now cross the lesion, disconnect, and perform the PCI over the OptoWire to finally reconnect to get the post-PCI measurement and confirm a successful procedure. And thanks to the accuracy of the Fidela sensor, we are now mostly using the diastolic Pressure Ratio (dPR) which is an adenosine-free index that makes the case even faster and safer.