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Percutaneous intentional intra-luminal-assisted recanalization (PILAR technique) of challenging chronic total

Stephanie Volpi1, Amine Chouiter2, Francois Saucy3

  • 1Cardio-Thoracic and Vascular Unit, Department of radiology, Centre Hospitalo-Universitaire Vaudois, Rue de Bugnon 46, CH-1011, Lausanne, Switzerland. stephanie.volpi@chuv.ch.

European Radiology
|May 24, 2018
PubMed

Insights

High-frequency vibrational device (HFVD)-assisted percutaneous intentional intraluminal-assisted recanalization (PILAR) offers a safe and effective first-line approach for challenging chronic total occlusions (CTOs). This technique demonstrates high success rates in recanalizing complex lesions, improving patient outcomes.

Area of Science:

  • Cardiovascular Interventions
  • Vascular Surgery
  • Medical Devices

Background:

  • Peripheral chronic total occlusions (CTOs) present significant recanalization challenges, particularly with in-stent, pre-stent, or heavily calcified lesions.
  • A high-frequency vibrational device (HFVD) has emerged as a potential tool for guidewire-refractory CTOs.

Purpose of the Study:

  • To evaluate the safety and efficacy of HFVD as a primary treatment for complex CTOs.
  • To establish the percutaneous intentional intraluminal-assisted recanalization (PILAR) technique using HFVD.

Main Methods:

  • Fifty-two patients with challenging CTOs (pre-stent, in-stent, calcified) underwent treatment with HFVD.
  • Technical success was defined by successful CTO crossing with HFVD; intraluminal crossing was a secondary outcome.
  • Safety endpoints included thromboembolism and perforation, with 3-month and 1-year follow-up for patency.

Main Results:

  • Technical success rate for CTO recanalization was 90%, with 83% achieving intraluminal crossing.
  • The average recanalized length was 91 mm; one thromboembolic event occurred and was successfully treated.
  • Primary patency rates were 92% at 3 months and 79% at 1 year.

Conclusions:

  • HFVD-based PILAR is a safe and effective strategy for recanalizing challenging CTOs, including long, calcified, in-stent, and pre-stent lesions.
  • Intraluminal recanalization is the preferred approach for complex CTOs.
  • First-line use of HFVD-assisted recanalization defines the PILAR technique, offering high success rates.
Abstract

Keywords:
AngioplastyEndovascular techniquesLower limbMedical devicePeripheral artery disease

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