WHAT IS WITH THE GUIDEWIRE OBSESSION?
You would think that just the thought of being able to treat those 200,000 patients a year in which a guidewire may have been the culprit as to why they are now lined up for amputation, doctors would do everything in their power to learn the limb-saving technique. Even if there was just a slight chance this device would work, wouldn't you think that a doctor would at least give it a try? Wouldn't you think they would want a device such as this even on-hand just in case other devices failed and prevent sentencing their patient to life in a wheelchair or even worse, death in the next two years as the mortality rate following major amputations is high for vascular disease patients?"
It seemed logical to me. But I discovered that some doctors have various relationships with different vendors that limit their ability and willingness to try a potentially limb-saving device, while others are unwilling to break current habits as they're comfortable with their current tools and techniques even if they don't have as high of a success rate and patients return regularly due to restenosis.
For the latter excuse, what really struck me in this journey is that while the guidewire seems to be a blessing in some cases, it can also be a curse for doctors.
First, it's a blessing because it does make navigating the vessel somewhat easier. Did you know that using a device other than the wire to navigate the vessel is not a new concept? Balloon angioplasty over-the-wire coaxial balloon system wasn't introduced until 1982. Andreas Greuntzig performed the first human coronary ballooon angioplasty intraoperatively in 1977. The reason the wire was introduced was because the coronary artery torchuosity made it difficult to navigate the balloons. This is not the case in the peripheral anatomy, but doctors are trained in medical school that the guidewire is the foundation of any interventional procedure.
Secondly, it's a curse because in scanning the MAUDE database on the FDA's website, I saw adverse event after adverse event caused by guidewires. It's very easy for a guidewire to perforate the vessel and find subintimal territory. So, if a device relies upon a guidewire to navigate the vessel, it can easily navigate the device straight into subintimal territory, causing trauma to the vessel. The DABRA Catheter tip is too large and blunt so it tends to not go subintimal.
So, wouldn't you think the doctors would gravitate towards a device that would navigate the vessel with basic wire technique and was safer for the patients?
Well, they're all willing to try it at least. It's just that breaking long-time habits it's tough.
I've watched the inventor then train doctors and offer step-by-step guidance and support through a procedure to clear blockages other devices couldn't and the proof is in the final run-off.
Seeing that final run-off, they quickly become believers.