ASAHI Conquest Pro/Confianza Pro: High Tip-Load Needle-Tip Wires for Calcified CTO Caps

The Confianza® Pro series represents the apex of Asahi Intecc’s CTO guidewire tip-load range, designed for the subset of CTO lesions — typically 15–20% of all cases — where the proximal fibrous cap is heavily calcified and resists all preceding wire escalation including Gaia Third or Gaia Next 3. The series consists of two grades: Confianza Pro (9 gf) and Confianza Pro 12 (12 gf).

Both wires share a tapered 0.009/0.014-inch tip that concentrates the wire’s tip load over a very small surface area — creating penetrating pressure (force per unit area) far in excess of the stated gf figure. This ‘needle-tip’ effect is what distinguishes Confianza Pro from MIRACLEbros 12 gf: despite MIRACLEbros 12 having a nominally higher gram-force, Confianza Pro’s tapered tip penetrates calcified caps more effectively by concentrating the same or lower force over a much smaller contact area.

An uncoated ball tip is used intentionally: the ball prevents inadvertent post-penetration wire advancement beyond the CTO segment if the wire suddenly ‘gives’ after cap penetration — a safety feature that reduces the risk of vessel perforation at the distal end of the occlusion. Confianza Pro is also marketed as ‘Conquest Pro’ in North America.

Both Confianza Pro variants: tip diameter 0.009 inch (tapered), shaft diameter 0.014 inch, uncoated ball tip, available in straight and J configurations, working lengths 180 cm and 300 cm. Tip loads: Confianza Pro — 9 gf; Confianza Pro 12 — 12 gf.

Catalog numbers: Confianza Pro 9 gf — AGH143090 (straight, 180/300 cm range), AGH143391 (J, 300 cm). Confianza Pro 12 gf — AGH143091 (12 gf straight), AGH143391 (12 gf J). Both straight and J configurations are available at both working lengths. The J-tip variant provides an alternative tip angle for caps where the proximal approach angle is better suited to a curved rather than straight wire entry.

Confianza Pro vs. Gaia Next 3 (6 gf): Gaia Next 3 is the standard step before Confianza Pro in the modern CTO algorithm. If Gaia Next 3 fails, Confianza Pro 9 gf is the next escalation for a calcified cap, unless an intermediate tip-load option is available as a bridging step. The transition from rotating-core (Gaia) to standard-core (Confianza Pro) is acceptable at this stage because the cap is too hard for tip torsion to be the limiting factor — direct axial penetration force is now the priority.

Confianza Pro 9 gf vs. 12 gf: Confianza Pro 12 is reserved for the most severely calcified caps that also resist Confianza Pro 9. In practice, 12 gf is rarely needed; most heavily calcified caps that respond to the Confianza Pro approach are crossed with 9 gf. Confianza Pro 12 is maintained in the inventory for the exceptional case where 9 gf is insufficient and the operator has confirmed true-cap resistance rather than subintimal deflection.

Confianza Pro vs. antegrade subintimal techniques: If Confianza Pro also fails, the operator should transition to an antegrade dissection-re-entry technique (Stingray system) rather than escalating further within the penetration wire algorithm. Confianza Pro failure at a calcified cap is a recognised decision point in all major CTO algorithms.

Confianza Pro is indicated after Gaia series failure in the antegrade wiring approach, specifically when the proximal cap is confirmed calcified on fluoroscopy or CTA and multiple rotating-core wire attempts have been unable to penetrate it. The wire is not appropriate as an early-escalation choice; its very high tip load carries a meaningful perforation risk if used before lower-load options have been attempted.

Blunt proximal caps — where there is no obvious entry point or micro-channel at angiography — are a specific subtype for which Confianza Pro is well-suited. The needle tip can create its own penetration pathway through a uniform calcified cap where no natural microchannel exists for Fielder XT or Gaia wires to probe.

In the retrograde approach, Confianza Pro is used at the proximal cap for retrograde-to-antegrade crossing when the retrograde wire is close to the proximal fibrous-calcified cap from the subintimal space. A controlled ‘rotate and penetrate’ technique from the retrograde side uses Confianza Pro’s tip load to perforate the proximal cap from the distal side for reverse CART completion.

Always use Corsair Pro (or Corsair Pro XS for tighter caps) positioned at the proximal cap face before engaging with Confianza Pro. The microcatheter is indispensable at this tip-load level: it prevents wire prolapse, provides back-support for penetration force transmission, and enables immediate wire exchange to a softer wire if true-lumen position is confirmed before balloon delivery.

Rotate, do not push: Confianza Pro’s needle tip penetrates calcified caps through rotational drilling rather than axial push. Apply minimal forward pressure — just enough to maintain tip-cap contact — and use slow, deliberate half-turn rotations. Excessive forward pressure with a 9 or 12 gf tip dramatically increases perforation risk. The wire should advance 1–2 mm per rotation cycle; if it is not advancing, withdraw and reassess.

Confirm true-lumen position immediately after any penetration: stop advancement as soon as resistance changes, withdraw the microcatheter to the wire tip, and inject contrast. An angiographic ‘puff’ or staining of the vessel wall indicates subintimal position. True-lumen confirmation shows contrast travelling antegrade in the vessel with normal staining pattern. Never advance a balloon over Confianza Pro without confirmed true-lumen position.

Modern Medical Solutions supplies Confianza® Pro 9 gf and Confianza® Pro 12 gf to CTO programmes in Tajikistan and Afghanistan as the authorised Asahi Intecc distributor. Both straight and J configurations in both working lengths are available. Confianza Pro is recommended as a standard component of the CTO wire inventory for any centre performing complex CTO procedures.

For centres initiating CTO programmes, Modern Medical Solutions can provide algorithm training incorporating Confianza Pro indications, technique guidance, and complication management protocols. Contact the team via the Modern Medical Solutions website.