WO2024020450A1

WO2024020450A1 - Coronary/vascular wire

Info

Publication number: WO2024020450A1
Application number: PCT/US2023/070507
Authority: WO
Inventors: Vinisha GARG; Heber CARRASCO
Original assignee: Loma Linda University Health
Priority date: 2022-07-19
Filing date: 2023-07-19
Publication date: 2024-01-25
Also published as: AU2023309003A1

Abstract

Disclosed herein is an intraluminal medical guidewire with a usable tip at each end of the guidewire. The guidewire includes an elongated member defining a longitudinal axis and having a first end and a second end. The first end contains a first tip. The second end contains a second tip that is different than the first tip.

Description

CORONARY/VASCULAR WIRE

CROSS REFERENCE

[0001] The present disclosure relates to and claims priority to U.S. Provisional Application No. 63/390,579, entitled “Coronary/Vascular Wire,” filed on July 19, 2022, the entire contents of which are incorporated herein by reference.

FIELD

[0002] The present disclosure relates to a double-sided guidewire, which includes a first tip at the first end of the guidewire and a second tip at the second end of the guidewire, and methods of use thereof.

BACKGROUND

[0003] Guidewires are thin flexible medical wires that are inserted into a patient during various medical procedures. Traditionally, the distal end of the guidewire is a tip, which is available in multiple configurations. The design of the tip influences the trackability and torqueability of the guidewire. After a procedural physician inserts the distal end of the guidewire into the patient and advances the tip to a desired location, the guidewire is used to guide the placement of a larger device, such as a catheter. Typically, proceduralists employ a J-tip guidewire to deliver devices into blood vessels within a patient. However, while placing the guidewire, proceduralists commonly encounter blood vessel narrowing and/or tortuosity that require a guidewire with a different tip. Thus, the proceduralist may remove the first guidewire containing the J- tip and, subsequently, insert and advance a second guidewire containing a more flexible tip.

[0004] Therefore, there is a need for a double-sided guidewire, which has a usable tip at each end of the guidewire, to simplify procedures by reducing the number of guidewires used. For example, the first end of the double-sided guidewire may have a more rigid tip, such as a J-tip. The second end of the double-sided guidewire may have floppy, more flexible tip, such as a floppy straight tip, a hydrophilic small J-tip, or an angled tip. If the proceduralist is unable to traverse a blood vessel using the first tip at the first end of the guidewire, then the proceduralist may use the second tip at the second end of the guidewire. SUMMARY

[0005] This disclosure provides a double-sided guidewire and methods of use thereof. One aspect of the present disclosure encompasses an intraluminal medical guidewire. The medical guidewire includes an elongated member having a first end and a second end. The first end has a first tip, and the second end has a second tip. The second tip may be different than the first tip.

[0006] The first tip may be a straight tip, an angled tip, or a J-tip and may be stiff. The second tip may be a straight tip, an angled tip, or a J-tip and may be floppy. The diameter of the guidewire may be between 0.018 inches and 0.038 inches and the length of the guidewire may be between 80 centimeters and 260 centimeters. The guidewire may be made of stainless steel, nitinol, or any memory metal and the guidewire may be coated in whole or in part.

[0007] Also disclosed is a method for using the double-sided guidewire. The method includes inserting the first end of the guidewire, which has a first tip, into a blood vessel of the patient and advancing the guidewire towards a desired location. The proceduralist may encounter an obstacle, which prevents the guidewire from traversing the obstacle. The method includes removing the guidewire from the blood vessel of the patient. Additionally, the method involves inserting the second end of the guidewire, which has a second tip, into the blood vessel of the patient and advancing the guidewire towards a desired location. The guidewire may be removed from the blood vessel of the patient.

[0008] The method may include using the guidewire as a guide to deliver a device within the blood vessel. The first tip may be a straight tip, an angled tip, or a J-tip and may be stiff. The second tip may be a straight tip, an angled tip, or a J-tip and may be floppy.

BRIEF DESCRIPTION OF THE DRAWINGS

[0009] The description will be more fully understood with reference to the following figures and data graphs, which are presented as various embodiments of the disclosure and should not be construed as a complete recitation of the scope of the disclosure. It is noted that, for purposes of illustrative clarity, certain elements in various drawings may not be drawn to scale. Understanding that these drawings depict only exemplary embodiments of the disclosure and are not therefore to be considered to be limiting of its scope, the principles herein are described and explained with additional specificity and detail through the use of the accompanying drawings in which:

[0010] FIG. 1 A is a photograph of a straight tip at one end of a guidewire.

[0011] FIG. 1 B illustrates a partial cross-sectional view of a straight tip at one end of a guidewire.

[0012] FIG. 2A is a photograph of a J-tip at one end of a guidewire.

[0013] FIG. 2B illustrates a partial cross-sectional view of a J-tip at one end of a guidewire.

[0014] FIG. 3A is a photograph of an angled tip at one end of a guidewire.

[0015] FIG. 3B illustrates an angled tip at one end of a guidewire.

DETAILED DESCRIPTION

[0016] Various embodiments of the disclosure are discussed in detail below. While specific implementations are discussed, it should be understood that this is done for illustration purposes only. A person skilled in the relevant art will recognize that other components and configurations may be used without parting from the spirit and scope of the disclosure. Thus, the following description and drawings are illustrative and are not to be construed as limiting. Numerous specific details are described to provide a thorough understanding of the disclosure. However, in certain instances, well-known or conventional details are not described in order to avoid obscuring the description. References to one or an embodiment in the present disclosure can be references to the same embodiment or any embodiment; and such references mean at least one of the embodiments.

[0017] Reference to “one embodiment”, “an embodiment”, or “an aspect” means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment of the disclosure. The appearances of the phrase “in one embodiment” or “in one aspect” in various places in the specification are not necessarily all referring to the same embodiment, nor are separate or alternative embodiments mutually exclusive of other embodiments. Moreover, various features are described which may be exhibited by some embodiments and not by others.

[0018] The terms used in this specification generally have their ordinary meanings in the art, within the context of the disclosure, and in the specific context where each term is used. Alternative language and synonyms may be used for any one or more of the terms discussed herein, and no special significance should be placed upon whether or not a term is elaborated or discussed herein. In some cases, synonyms for certain terms are provided. A recital of one or more synonyms does not exclude the use of other synonyms. The use of examples anywhere in this specification including examples of any terms discussed herein is illustrative only, and is not intended to further limit the scope and meaning of the disclosure or of any example term. Likewise, the disclosure is not limited to various embodiments given in this specification.

[0019] Additional features and advantages of the disclosure will be set forth in the description which follows, and in part will be obvious from the description, or can be learned by practice of the herein disclosed principles. The features and advantages of the disclosure can be realized and obtained by means of the instruments and combinations particularly pointed out in the appended claims. These and other features of the disclosure will become more fully apparent from the following description and appended claims, or can be learned by the practice of the principles set forth herein.

[0020] Provided herein is a double-sided guidewire, that contains a usable tip at each end of the guidewire, and methods of use thereof to improve the ability of a guidewire to transverse blood vessel lumens (i.e., intraluminal) within a patient. As illustrated in FIGS. 1 A-B, the first end and/or the second end of the guidewire may be a straight tip. In other embodiments, the first end and/or the second end of the guidewire may be a J-tip, as illustrated in FIGS. 2A-B. In other embodiments, as illustrated in FIGS. 3A-B, the first end and/or the second end of the guidewire may be an angled tip. In one embodiment, the second end of the guidewire may contain a second tip, that is different than the first tip at the first end of the guidewire.

[0021] The double-sided guidewire may have significant advantages over traditional guidewires. Currently, guidewires contain only one tip at the distal end of the guidewire. A procedural physician selects a guidewire with a specific tip, inserts the guidewire into a blood vessel, and advances the guidewire. However, if the tip of the guidewire cannot traverse an obstacle within the blood vessel, then the proceduralist may remove the first guidewire. Subsequently, in an attempt to traverse the obstacle, the proceduralist may insert and advance a second guidewire with a more flexible tip than the first guidewire. [0022] The double-sided guidewire may increase functionality, thereby simplifying procedures and increasing procedural success. The double-sided guidewire contains a useable tip at each end of the guidewire, which may allow only one guidewire to be used during a procedure. If the tip at the first end of the double-sided guidewire cannot traverse an obstacle, then the tip at the second end (i.e., the alternate end or opposite end) of the guidewire, which will typically be a more flexible wire, can be used to attempt to traverse the obstacle.

[0023] The double-sided guidewire may reduce costs associated with the procedure. Currently, the proceduralist selects and opens a guidewire at the beginning of the procedure. However, if the proceduralist encounters an issue that prevents access or delivery within the blood vessel with that guidewire, then the proceduralist requests one or more additional guidewires to be opened to attempt to traverse the obstacle and improve device delivery. The double-sided guidewire may substantially reduce, if not eliminate, the need to open two or more guidewires per procedure, which may reduce costs for the medical facility and/or the patient.

[0024] FIGS. 1A-B illustrate a guidewire 100 with a straight tip. The guidewire 100 comprises an elongated member 102 (i.e., elongated body), which may be made of a flexible material or flexible materials. The elongated member 102 defines a longitudinal axis, which refers to an axis along the centerline of the elongated member 102, between the first end 104 and the second end 106. In other words, the longitudinal axis follows the path of the elongated member 102, which may be bent, curved, or otherwise manipulated. Therefore, when the elongated member 102 is manipulated during use, the longitudinal axis varies with the centerline of the elongated member 102. The outer diameter of the guidewire 100 may range from 0.010 inches to 0.038 inches. The length of the guidewire 100 may range from 40 centimeters to 450 centimeters. For example, the guidewire 100 may be approximately 180 centimeters or 260 centimeters long in various embodiments.

[0025] The elongated member 102 defines a first end 104 and a second end 106. The elongated member 102 does not have a designated proximal end and distal end, because the double-sided guidewire 100 includes two usable ends. When the first end 104 of the elongated member 102 is inserted into a patient, then the first end 104 is the distal end and the second end 106 is the proximal end. However, the orientation of the guidewire 100 may be reversed so that the second end 106 is inserted into the patient. When the second end 106 of the elongated member 102 is inserted into a patient, then the second end 106 is the distal end and the first end 104 is the proximal end. In one embodiment, the first end 104 and/or second end 106 may be configured as a straight tip. In some embodiments, the opposite end (i.e., the first end 104 and/or second end 106) may be configured as a different tip, such as an angled tip or a J-tip. [0026] The elongated member 102 of the guidewire 100 may comprise a core wire 108. The core wire 108 may be a solid wire. In some embodiments, the core wire 108 may be wrapped with a coil wire 110 or braided wire. The core wire 108 may be tapered, (i.e., configured as a short taper or a long taper) near the first end 104 and/or second end 106 of the elongated member 102. The core wire 108 may contain a length that is equal to or less than the length of the elongated member 102. In one example, the core wire 108 may extend between the first end 104 and the second end 106 of the elongated member 102. In another example, the core wire 108 may not extend to the first end 104 and/or second end 106 of the elongated member 102.

[0027] The elongated member 102 may further comprise a coil wire 110. The coil wire 110 may be an outer spring that encases the core wire 108, in full or in part. The coil wire 110 may contain a length that is equal to or less than the length of the elongated member 102. In one example, the coil wire 110 may extend between the first end 104 and the second end 106 of the elongated member 102. In another example, the coil wire 110 may not extend to the first end 104 and/or second end 106 of the elongated member 102.

[0028] The elongated member 102 may further comprise a ribbon wire 112. The ribbon wire 112 may be a wire that is located alongside the core wire 108, or a portion thereof, and encased by the coil wire 110. The ribbon wire 112 may contain a length that is equal to or less than the length of the elongated member 102. In one example, the ribbon wire 112 may extend between the first end 104 and the second end 106 of the elongated member 102. In other example, the ribbon wire 112 may not extend to the first end 104 and/or second end 106 of the elongated member 102.

[0029] The core wire 108 and/or the ribbon wire 112 may be made of metal. For example, the core wire 108 and/ or the ribbon wire 112 may be made of stainless steel, nitinol, or any memory metal. Similarly, the coil wire 1 10 may be made of metal. By way of example and not limitation, the coil wire 110 may be made of stainless steel, nitinol, platinum, tungsten, nickel, titanium, or combinations thereof. The outer surface of the guidewire 100 may be coated, in whole or in part. For example, the guidewire 100 may be coated with a hydrophilic coating, a hydrophobic coating, and/or an oleophobic coating. The hydrophilic coating may be configured to attract water, whereas the hydrophobic coating may be configured to repel water. The oleophobic coating may be configured to repel oil. For example, the guidewire 100 may be coated with a polymer. The polymer coating may be silicone or polytetrafluoroethylene (PTFE). Additionally, the guidewire 100 may include one or more radiopaque markers that are made of suitable radiopaque materials. For example, the radiopaque markers may be made of gold or platinum. In some embodiments, the radiopaque markers may be incorporated into the coil wire 110.

[0030] In some embodiments, the straight tip may be flexible or floppy. For example, the straight tip may comprise a coil wire 110 that extends to the end of the tip (i.e., the first end 104 or second end 106) and a core wire 108 that does not extend to the end of the tip. In other embodiments, the straight tip may be more stiff or rigid. For example, the straight tip may comprise a core wire 108 that extends to the end of the tip.

[0031] FIGS. 2A-B illustrate a guidewire 200 with a J-tip. The guidewire 200 comprises an elongated member 202 (i.e., elongated body), which may be made of a flexible material orflexible materials. The elongated member 202 defines a longitudinal axis, which refers to an axis along the centerline of the elongated member 202, between the first end 204 and the second end 206. In other words, the longitudinal axis follows the path of the elongated member 202, which may be bent, curved, or otherwise manipulated. Therefore, when the elongated member 202 is manipulated during use, the longitudinal axis varies with the centerline of the elongated member 202. The outer diameter of the guidewire 200 may range from 0.010 inches to 0.038 inches. The length of the guidewire 200 may range from 40 centimeters to 450 centimeters, according to various embodiments. For example, the guidewire 200 may be approximately 180 centimeters long. In other examples, the guidewire 200 may be 50 cm, 100 cm, 150 cm, 260 cm,

[0032] The elongated member 202 defines a first end 204 and a second end 206. The elongated member 202 does not have a designated proximal end and distal end, because the double-sided guidewire 200 includes two usable ends. When the first end 204 of the elongated member 202 is inserted into a patient, then the first end 204 is the distal end and the second end 206 is the proximal end. However, the orientation of the guidewire 200 may be reversed so that the second end 206 is inserted into the patient. When the second end 206 of the elongated member 202 is inserted into a patient, then the second end 206 is the distal end and the first end 204 is the proximal end. In one embodiment, the first end 204 and/or second end 206 may be configured as a J-tip. The J-tip may comprise a bent tip. In some embodiments, the opposite end (i.e., the first end 204 and/or second end 206) may be configured as a different tip, such as a straight tip or an angled tip.

[0033] The elongated member 202 of the guidewire 200 may comprise a core wire 208. The core wire 208 may be a solid wire. In some embodiments, the core wire 208 may be wrapped with a coil wire 210 or braided wire. The core wire 208 may be tapered, (i.e., configured as a short taper or a long taper) near the first end 204 and/or second end 206 of the elongated member 202. The core wire 208 may contain a length that is equal to or less than the length of the elongated member 202. In one example, the core wire 208 may extend between the first end 204 and the second end 206 of the elongated member 202. In another example, the core wire 208 may not extend to the first end 204 and/or second end 206 of the elongated member 202.

[0034] The elongated member 202 may further comprise a coil wire 210. The coil wire 210 may be an outer spring that encases the core wire 208, in full or in part. The coil wire 210 may contain a length that is equal to or less than the length of the elongated member 202. In one example, the coil wire 210 may extend between the first end 204 and the second end 206 of the elongated member 202. In another example, the coil wire 210 may not extend to the first end 204 and/or second end 206 of the elongated member 202.

[0035] The elongated member 202 may further comprise a ribbon wire 212. The ribbon wire 212 may be a wire that is located alongside the core wire 208, or a portion thereof, and encased by the coil wire 210. The ribbon wire 212 may contain a length that is equal to or less than the length of the elongated member 202. In one example, the ribbon wire 212 may extend between the first end 204 and the second end 206 of the elongated member 202. In other example, the ribbon wire 212 may not extend to the first end 204 and/or second end 206 of the elongated member 202.

[0036] The core wire 208 and/or the ribbon wire 212 may be made of metal. For example, the core wire 208 and/ or the ribbon wire 212 may be made of stainless steel, nitinol, or any memory metal. Similarly, the coil wire 210 may be made of metal. For example without limitation, the coil wire 210 may be made of stainless steel, nitinol, platinum, nickel, titanium, or tungsten. The outer surface of the guidewire 200 may be coated, in whole or in part. For example, the guidewire 200 may be coated with a hydrophilic coating, a hydrophobic coating, and/or an oleophobic coating. The hydrophilic coating may be configured to attract water, whereas the hydrophobic coating may be configured to repel water. The oleophobic coating may be configured to repel oil. For example, the guidewire 200 may be coated with a polymer. The polymer coating may be silicone or polytetrafluoroethylene (PTFE). Additionally, the guidewire 200 may include one or more radiopaque markers that are made of suitable radiopaque materials. For example, the radiopaque markers may be made of gold or platinum. In some embodiments, the radiopaque markers may be incorporated into the coil wire 210.

[0037] In some embodiments, the J-tip may be flexible or floppy. For example, the J-tip may comprise a coil wire 210 that extends to the end of the tip (i.e., the first end 204 or second end 206) and a core wire 208 that does not extend to the end of the tip. In other embodiments, the J-tip may be more stiff or rigid. For example, the J-tip may comprise a core wire 208 that extends to the end of the tip. The J-tip may be a larger sized J-tip or a smaller sized J-tip. For example, in one embodiment, the J-tip may have a 1.5 mm radius curve, while in another embodiment, the J-tip may have a 3 mm radius curve.

[0038] FIGS. 3A-B illustrate a guidewire 300 with an angled (i.e., curved) tip. The guidewire 300 comprises an elongated member 302 (i.e., elongated body), which may be made of a flexible material or flexible materials. The elongated member 302 defines a longitudinal axis, which refers to an axis along the centerline of the elongated member 302, between the first end 304 and the second end 306. In other words, the longitudinal axis follows the path of the elongated member 302, which may be bent, curved, or otherwise manipulated. Therefore, when the elongated member 302 is manipulated during use, the longitudinal axis varies with the centerline of the elongated member 302. The outer diameter of the guidewire 300 may range from 0.010 inches to 0.038 inches. The length of the guidewire 300 may range from 40 centimeters to 450 centimeters. For example, the guidewire 300 may be approximately 180 centimeters long. [0039] The elongated member 302 defines a first end 304 and a second end 306. The elongated member 302 does not have a designated proximal end and distal end, because the double-sided guidewire 300 includes two usable ends. When the first end 304 of the elongated member 302 is inserted into a patient, then the first end 304 is the distal end and the second end 306 is the proximal end. However, the orientation of the guidewire 300 may be reversed so that the second end 306 is inserted into the patient. When the second end 306 of the elongated member 302 is inserted into a patient, then the second end 306 is the distal end and the first end 304 is the proximal end. In one embodiment, the first end 304 and/or second end 306 may be configured as an angled tip. The angled tip may contain a bend of less than 90-degrees. In some embodiments, the opposite end (i.e. , the first end 304 and/or second end 306) may be configured as a different tip, such as a straight tip or a J-tip.

[0040] The elongated member 302 of the guidewire 300 may comprise a core wire. The core wire may be a solid wire. In some embodiments, the core wire may be wrapped with a coil wire or braided wire. The core wire may be tapered, (i.e., configured as a short taper or a long taper) near the first end 304 and/or second end 306 of the elongated member 302. The core wire may contain a length that is equal to or less than the length of the elongated member 302. In one example, the core wire may extend between the first end 304 and the second end 306 of the elongated member 302. In another example, the core wire may not extend to the first end 304 and/or second end 306 of the elongated member 302.

[0041] The elongated member 302 may further comprise a coil wire. The coil wire may be an outer spring that encases the core wire, in full or in part. The coil wire may contain a length that is equal to or less than the length of the elongated member 302. In one example, the coil wire may extend between the first end 304 and the second end 306 of the elongated member 302. In another example, the coil wire may not extend to the first end 304 and/or second end 306 of the elongated member 302.

[0042] The elongated member 302 may further comprise a ribbon wire. The ribbon wire may be a wire that is located alongside the core wire, or a portion thereof, and encased by the coil wire. The ribbon wire may contain a length that is equal to or less than the length of the elongated member 302. In one example, the ribbon wire may extend between the first end 304 and the second end 306 of the elongated member 302. In other example, the ribbon wire may not extend to the first end 304 and/or second end 306 of the elongated member 302.

[0043] The core wire and/or the ribbon wire may be made of metal. For example, the core wire and/ or the ribbon wire may be made of stainless steel, nitinol, or any memory metal. Similarly, the coil wire may be made of metal. For example, the coil wire may be made of stainless steel, nitinol, platinum, or tungsten. The outer surface of the guidewire 300 may be coated, in whole or in part. For example, the guidewire 300 may be coated with a hydrophilic coating, a hydrophobic coating, and/or an oleophobic coating. The hydrophilic coating may be configured to attract water, whereas the hydrophobic coating may be configured to repel water. The oleophobic coating may be configured to repel oil. For example, the guidewire 300 may be coated with a polymer. The polymer coating may be silicone or polytetrafluoroethylene (PTFE). Additionally, the guidewire 300 may include one or more radiopaque markers that are made of suitable radiopaque materials. For example, the radiopaque markers may be made of gold or platinum. In some embodiments, the radiopaque markers may be incorporated into the coil wire.

[0044] In some embodiments, the angled tip may be flexible or floppy. For example, the angled tip may comprise a coil wire that extends to the end of the tip (i.e., the first end 304 or second end 306) and a core wire that does not extend to the end of the tip. In other embodiments, the angled tip may be more stiff or rigid. For example, the angled tip may comprise a core wire that extends to the end of the tip. By way of example and not limitation, the double-ended guidewire may have a combination of wire tips, selected from a standard J-tip, a floppy tip, a baby J-tip, and angled glide tip, among others.

[0045] The guidewire 100, 200, 300 may be configured for use in the neurovascular, cardiovascular, or peripheral vascular system of a patient. In other words, the guidewire 100, 200, 300 may be configured to provide the proceduralist with varying levels of trackability, torqueability, flexibility, crossability, and supportability, which are determined by the physical characteristics of the guidewire 100, 200, 300. The guidewire 100, 200, 300 may be used by any proceduralist employing wires to advance catheters or other devices into the blood vessels of a patient. For example, such proceduralists may include cardiologists, interventional radiologists, and vascular surgeons. [0046] The proceduralist may insert the first end 104, 204, 304, which contains the first tip, of the elongated member 102, 202, 302 of the guidewire 100, 200, 300 into a blood vessel lumen of the patient. The blood vessel may include arteries, arterioles, capillaries, venules, and veins. The proceduralist may advance the first end 104, 204, 304 to a desired location within the blood vessel. The desired location may be a lesion, a blood vessel segment, or otherwise a treatment site. In order to advance the first end 104, 204, 304 and traverse the blood vessel, the proceduralist may move, manipulate, or torque the elongated member 102, 202, 302 of the guidewire 100, 200, 300.

[0047] The blood vessel may contain an obstruction that hinders or prevents the first end 104, 204, 304 of the elongated member 102, 202, 302 of the guidewire 100, 200, 300 from traversing the obstacle. Blood vessel obstructions may include narrowing of the blood vessel and/or tortuous (i.e., twisted) blood vessels. If the first end 104, 204, 304 cannot traverse the obstacle, then the proceduralist may remove the guidewire 100, 200, 300 from the blood vessel lumen of the patient. Then, the proceduralist may insert the second end 106, 206, 306, which contains the second tip, of the elongated member 102, 202, 302 of the guidewire 100, 200, 300 into the blood vessel lumen of the patient and advance the second end 106, 206, 306 to a desired location within the blood vessel. The second tip at the second end 106, 206, 306 may be more flexible than the first tip at the first end 104, 204, 304 of the elongated member 102, 202, 302 of the guidewire 100, 200, 300.

[0048] After reaching the desired location within the blood vessel of the patient, a larger device may be advanced to the desired location by using the guidewire 100, 200, 300 to guide the larger device to a position within the blood vessel. In other words, the guidewire 100, 200, 300 may be used as a guide to deliver the larger device to a position within the blood vessel. The position may be the desired location within the blood vessel and the larger device may include a catheter. The proceduralist may remove the guidewire 100, 200, 300 from the blood vessel lumen of the patient and, in some cases, the proceduralist may remove the device from the blood vessel lumen of the patient.

Claims

CLAIMS What is claimed is:

1. An intraluminal medical guidewire, comprising: an elongated member defining a longitudinal axis and having a first end configured for intraluminal placement and a second end configured for intraluminal placement; and wherein the first end has a first tip, and the second end has a second tip different than the first tip.

2. The intraluminal medical guidewire of claim 1 , wherein the first tip is a straight tip, an angled tip, or a J-tip.

3. The intraluminal medical guidewire of claim 2, wherein the first tip is stiff.

4. The intraluminal medical guidewire of claim 1 , wherein the second tip is a straight tip, an angled tip, or a J-tip.

5. The intraluminal medical guidewire of claim 4, wherein the second tip is floppy.

6. The intraluminal medical guidewire of claim 1 , wherein the guidewire is between 0.018 inches and 0.038 inches in diameter.

7. The intraluminal medical guidewire of claim 1 , wherein the guidewire is between 80 centimeters and 260 centimeters in length.

8. The intraluminal medical guidewire of claim 1 , wherein the guidewire is made of stainless steel, or nitinol, or a memory metal.

9. The intraluminal medical guidewire of claim 1 , wherein the guidewire is coated in whole or in part.

10. A method of using a guidewire having a first end configured for intraluminal placement and a second end configured for intraluminal placement, the method comprising: inserting the first end of the guidewire into a blood vessel of a patient, the first end having a first tip; advancing the first tip of the guidewire towards a desired location within the blood vessel; encountering an obstacle within the blood vessel, wherein the first tip of the guidewire cannot traverse the obstacle; removing the guidewire from the blood vessel of the patient; inserting the second end of the guidewire into the blood vessel of the patient, the second end having a second tip different than the first tip; advancing the second tip of the guidewire within the blood vessel; and removing the guidewire from the blood vessel of the patient.

11 . The method of claim 10 further comprising using the guidewire as a guide to deliver a device to a location within the blood vessel.

12. The method of claim 10, wherein the first tip is a straight tip, an angled tip, or a J-tip.

13. The method of claim 12, wherein the first tip is stiff.

14. The method of claim 10, wherein the second tip is a straight tip, an angled tip, or a J-tip.

15. The method of claim 14, wherein the second tip is floppy.