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BackTable Vascular & Interventional
Ep. 410 True Lumen Re-Entry with Pioneer Plus with Dr. Thomas Davis
Jan 25, 2024
Interventional cardiologist Dr. Thomas Davis discusses the Pioneer Plus Catheter for treating critical limb ischemia. He explains the reorientation technique to stay in the true lumen while treating chronic total occlusion. Dr. Davis shares post-procedure patient management and imaging follow-up, emphasizing the opportunities to learn more about peripheral vascular disease treatment.
34:19
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Quick takeaways
- The use of the Pioneer Plus catheter and IVUS-guided re-orientation allows for successful re-entry into the true lumen in complex cases of chronic limb-threatening ischemia (CLI)
- Post-procedural imaging with regular duplex follow-ups is crucial in ensuring healing and optimizing outcomes for CLI patients
Deep dives
Re-entry Devices in CLI and the Pioneer Plus Catheter
Dr. Thomas Davis discusses the use of re-entry devices in chronic limb-threatening ischemia (CLI), with a focus on the Pioneer Plus catheter. He emphasizes the importance of finding options to re-enter the true lumen in complex disease states like total occlusions and multilevel disease. He mentions that most of their cases are CTOs (chronic total occlusions) and the difficulty in staying in the true lumen for lengthy lesions. Dr. Davis highlights the use of IVUS-guided re-orientation and re-entry devices, like the Pioneer Plus catheter, to stay in the true lumen and achieve better outcomes. He also explains how he reorients the wire to avoid going subintimal and uses IVUS to assess plaque morphology and vessel size. Dr. Davis shares tips on the technique, including the use of a stiffer wire for puncturing and the importance of reducing wire escalation in subintimal spaces. He mentions that the Pioneer Plus catheter works well, although sometimes additional dilation may be necessary. Dr. Davis provides insights into troubleshooting and situations where different re-entry devices may be preferred, such as heavily calcified vessels and infrapopliteal vessels. He concludes by advising physicians to commit to building expertise in peripheral vascular interventions and highlights the importance of cross-specialty collaboration.
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