
Great item overall, but notably lacks the ability to finish off a foe you've spent your turn weakening. After looking through the windows for fast actions there's one before each of your actions during your turn, assuming I'm reading it right, but there isn't a window AFTER your last action.
Since the Garrote Wire can only be used during your turn, if you spend your entire turn chasing down a monster and manage to bring it down to one life, you can awkwardly have your turn end with a piano wire all ready to use and a nightgaunt all ready to be choked out without the opportunity to ever use it.
It still gets plenty of mileage for sure, but due to timing it has felt pretty awkward to use sometimes.