The Performance of High Tip Load Polymer Jacket Guidewires in Chronic Total Occlusion Revascularization.

BACKGROUND: Guidewire selection influences chronic total occlusion (CTO) percutaneous coronary intervention (PCI) success. High-tip-load (>1.5 g) polymer-jacketed guidewires (PJWs) combine penetration capability and lubricity, but comparative data versus non-polymer-jacketed penetration wires are limited. AIMS: To compare procedural outcomes between high-tip-load PJWs and non-PJW penetration guidewires in CTO PCI. METHODS: We retrospectively analyzed 1,850 consecutive CTO PCI procedures performed between January 2020 and June 2025. The analytical cohort comprised 220 PJW and 642 non-PJW procedures. Inverse probability of treatment weighting (IPTW) adjusted for 39 covariates; a propensity-score-matched sensitivity analysis yielded 208 pairs. RESULTS: After IPTW adjustment, PJW use was associated with higher antegrade recanalization (OR 1.79, 95% CI 1.06-3.02; p = 0.028), whereas procedural success was not significantly different (OR 2.10, 95% CI 0.97-4.52; p = 0.059). Procedure time and air kerma were lower with PJWs. Unadjusted perforation rates did not differ (4.1% vs 5.1%; OR 0.79, 95% CI 0.37-1.67; p = 0.530), whereas the matched analysis suggested fewer perforations with PJWs (3.4% vs 8.2%; OR 0.39, 95% CI 0.16-0.97; p = 0.042). Because only 24 matched events occurred, this safety finding should be considered hypothesis-generating. In-hospital major adverse cardiac events did not differ (p = 0.954). CONCLUSION: High-tip-load PJWs achieved comparable procedural success, higher antegrade recanalization, improved procedural efficiency, and a potential matched-cohort safety signal. They may be considered before escalation to high-force penetration wires.