ASAHI ULTIMATEbros3 Guidewire: Bridging the Gap in CTO Wire Escalation

ULTIMATEbros® 3 is a CTO guidewire from Asahi Intecc with a tip load of approximately 3 gf, occupying the escalation position between Fielder XT (0.8 gf) and the Gaia First (1.7 gf) / Gaia Second (3.5 gf) series. Its defining features are the uncoated ball tip — providing tactile feedback similar to MIRACLEbros — and the 40 cm hydrophilic coating zone that extends proximally from the tip to facilitate device advancement once the wire has crossed.

The wire is 0.014 inch in diameter throughout (non-tapered), which distinguishes it from Fielder XT’s tapered 0.009/0.014 inch design. This means ULTIMATEbros 3 cannot probe microchannels the way Fielder XT can, but it applies greater force at the cap surface and is preferred when the cap anatomy is clearly fibrous rather than micro-channelled.

The 11 cm coil segment is relatively short, concentrating flexibility near the tip while the longer 40 cm hydrophilic zone proximally ensures smooth device delivery. ULTIMATEbros 3 is available in straight and J configurations at 180 cm and 300 cm.

Outer diameter: 0.014 inch (non-tapered). Tip load: approximately 3 gf. Coil length: 11 cm. Hydrophilic coating: 40 cm from tip (hydrophilic only, uncoated ball at the very tip). Tip shapes: straight and J. Working lengths: 180 cm and 300 cm.

Catalog numbers: AHW14S003 (straight, 180 cm), AHW14S303 (straight, 300 cm), AHW14S003J (J-tip, 180 cm), AHW14S303J (J-tip, 300 cm). The uncoated ball tip provides direct tactile feedback to the operator’s fingers through the wire shaft when the tip contacts different tissue densities — soft fibrous tissue feels different from calcified cap, enabling real-time assessment of cap characteristics during crossing attempts.

ULTIMATEbros 3 vs. Gaia First (1.7 gf): ULTIMATEbros 3 applies nearly twice the tip load of Gaia First and does so with a standard (non-rotating) core. For straightforward fibrous caps without significant tortuosity, ULTIMATEbros 3’s higher tip load may be more effective than Gaia First’s superior torque transmission. In tortuous vessels, Gaia First’s rotating core advantages become more relevant.

ULTIMATEbros 3 vs. MIRACLEbros 3 gf: Both have approximately 3 gf tip loads and uncoated ball tips, but ULTIMATEbros 3 has a hydrophilic coating zone (40 cm) while MIRACLEbros uses a silicone coating. The hydrophilic zone of ULTIMATEbros 3 provides lower friction for device advancement, while MIRACLEbros’s silicone coating provides more consistent tactile feedback along a longer shaft segment.

ULTIMATEbros 3 vs. Confianza Pro (9 gf): ULTIMATEbros 3 is a gentler intermediate step and is preferred when there is uncertainty about whether the cap truly requires Confianza Pro’s needle-tip approach. Its full 0.014-inch diameter means larger contact area at the cap than Confianza Pro’s tapered needle tip, which distributes the 3 gf over a slightly wider surface.

ULTIMATEbros 3 is most often used as the second or third CTO wire in the antegrade escalation sequence: after Fielder XT fails to probe a microchannel (suggesting a uniformly dense fibrous cap without obvious channels), ULTIMATEbros 3 is deployed to attempt direct cap penetration before committing to Gaia Second or Confianza Pro.

In the classic tiered-penetration approach (favoured by many Asian CTO operators), ULTIMATEbros 3 bridges the initial escalation from probing wires to penetrating wires. The uncoated ball tip’s tactile feedback is particularly valued in this approach, allowing the operator to characterise whether the cap is uniformly fibrous (continued escalation appropriate) or calcified (consider Gaia series or subintimal approach).

For retrograde CTO cases, ULTIMATEbros 3 can be used at the distal cap for antegrade crossing attempts when the retrograde wire has entered the subintimal space from the opposite side, providing sufficient force to cross the distal fibrous cap remnant from the subintimal approach direction.

Use with microcatheter support (Corsair Pro positioned at the proximal cap). The non-tapered tip means ULTIMATEbros 3 engages the cap over a wider surface area than tapered wires — apply steady rotation rather than heavy forward pressure, allowing the tip load to do the work. Limit forward pressure to the minimum needed to maintain tip-cap contact while rotating.

The 40 cm hydrophilic zone facilitates post-crossing device advancement but requires the wire to remain wet throughout the procedure. Keep the wire tip moist by periodically injecting saline through the microcatheter; a dry hydrophilic coating loses its lubricity and may stick to vessel walls, increasing the risk of tip migration during device advancement.

If the tip feels ‘gritty’ rather than smooth during rotation (a consistent crunching sensation rather than intermittent resistance), this indicates calcified rather than fibrous cap material. At this point, escalate to Gaia Second (3.5 gf, rotating core) or Third rather than persisting with ULTIMATEbros 3, which lacks the rotating core advantage for calcified cap penetration.

Modern Medical Solutions supplies ULTIMATEbros® 3 in all four configurations (AHW14S003, AHW14S303, AHW14S003J, AHW14S303J) to catheterisation laboratories in Tajikistan and Afghanistan. The wire is recommended as part of a comprehensive CTO wire set alongside Fielder XT, the Gaia series, and Confianza Pro.

Contact Modern Medical Solutions via the website for stock availability and ordering. For centres new to CTO wiring, clinical specialists can advise on optimal escalation sequences incorporating ULTIMATEbros 3. Manufacturer specifications: medical.asahi-intecc.com.