Cardio-Thoracic and Vascular Unit, Department of radiology, Centre Hospitalo-Universitaire Vaudois, Rue de Bugnon 46, CH-1011, Lausanne, Switzerland.
Department of Radiology, Hôpital de la Providence, Neuchâtel, Switzerland.
Eur Radiol. 2018 Nov;28(11):4792-4799. doi: 10.1007/s00330-018-5479-y. Epub 2018 May 22.
Recanalization of peripheral chronic total occlusions (CTO) is technically challenging especially in cases of in-stent and/or pre-stent and heavily calcified lesions. A high-frequency vibrational device (HFVD) was first used as a secondary-intention device in CTO recanalizations when they were refractory to a guidewire. The aim of this study was to assess the safety and efficacy of the HFVD as a first-line treatment for challenging CTOs and thus to define the percutaneous intentional intraluminal-assisted recanalization (PILAR) technique.
Fifty-two patients were treated with the HFVD. Only challenging CTOs were included: 7 pre-stent, 7 in-stent, and 38 highly calcified CTOs. Technical success was defined as the ability to cross the CTO using the HFVD. Secondary outcome was defined as successful intraluminal crossing. Safety endpoints were procedure-related thromboembolism or perforation. Patients were followed up at 3 months and 1 year.
The technical success rate for recanalization was 90%, of which 83% were intraluminal. The mean recanalized length was 91 ± 44 mm. One thromboembolic complication occurred, which was subsequently treated with thromboaspiration. Three-month and 1-year primary patency rates were 92% and 79%, respectively.
HFVD-based PILAR is a safe and effective technique for in-stent or pre-stent CTO recanalization of long and calcified lesions.
• Intraluminal recanalization is the preferred procedure in heavily calcified or pre-/in-stent CTO. • First-line use of assisted intraluminal recanalization for CTO defines the PILAR technique. • HFVD-based PILAR is safe and provides a high success rate for challenging CTO recanalization.
外周慢性完全闭塞（CTO）的再通技术极具挑战性，尤其是在支架内和/或支架内及重度钙化病变的情况下。高频振动装置（HFVD）最初被用作 CTO 再通的二线设备，用于对抗导丝的难治性病变。本研究旨在评估 HFVD 作为治疗挑战性 CTO 的一线治疗方法的安全性和有效性，从而定义经皮腔内辅助腔内再通（PILAR）技术。
52 例患者接受 HFVD 治疗。仅纳入具有挑战性的 CTO：7 例为支架内，7 例为支架内，38 例为高度钙化 CTO。技术成功定义为能够使用 HFVD 穿过 CTO。次要结果定义为成功腔内穿越。安全性终点为与操作相关的血栓栓塞或穿孔。患者在 3 个月和 1 年时进行随访。
再通的技术成功率为 90%，其中 83%为腔内。再通长度的平均值为 91±44mm。发生 1 例血栓栓塞并发症，随后进行血栓抽吸治疗。3 个月和 1 年的原发性通畅率分别为 92%和 79%。
基于 HFVD 的 PILAR 是一种安全有效的技术，适用于长段和钙化病变的支架内或支架内前 CTO 再通。
腔内再通是重度钙化或支架内/前 CTO 的首选方法。
辅助腔内再通的一线应用定义了 PILAR 技术。
基于 HFVD 的 PILAR 是安全的，为挑战性 CTO 再通提供了高成功率。
