Guidewire Morphology as a Predictor of Vascular Tortuosity and Advancement Difficulties During Right Upper Limb Coronary Angiography

BackgroundVascular tortuosity in the right subclavian artery (RSA) region may impede guidewire advancement during right upper limb access for coronary angiography. AimsTo develop a morphology-based classification of guidewire configurations in the RSA region and evaluate their association with difficulty in guidewire manipulation. MethodsData were collected from patients who underwent coronary angiography via the right upper limb at the Geriatric Cardiovascular Center of Beijing Anzhen Hospital from January to May 2025. We conducted a retrospective study. Imaging data were analyzed, and guidewires were classified into four distinct types. Logistic and linear regression analyses were performed to investigate the relationships between guidewire shape, advancement difficulty, and frame counts. ResultsThis study included 398 patients, with a mean age of 65 (58-71) years. Type 1 accounted for 260 cases (65.32%), type 2 for 70 cases (17.59%), type 3 for 52 cases (13.07%), and type 4 for 16 cases (4.02%), with 125 patients (31.41%) experiencing difficulty with guidewire advancement. Morphological classification was significantly positively correlated with guidewire passage difficulties and frame count (P < 0.001). Type 3 morphology and vascular calcification were the strongest risk indicators for guidewire passage difficulty. ConclusionsDuring right upper limb coronary angiography, difficulty in advancing the guidewire is relatively common, primarily due to tortuosity and calcification. Classifying guidewire morphology in the RSA region into four types and identifying vascular calcification may save angiography time, reduce radiation exposure, and decrease vascular complications.