title: Peripheral chronic total occlusions treated with subintimal angioplasty and a true lumen re-entry device.
abstract: OBJECTIVE
  We sought to verify how effective the Pioneer catheter (Medtronic, Inc., Minneapolis, Minnesota) is in overcoming the complexity of re-entry during subintimal angioplasty and provide a case series describing the technique.
  
  
  BACKGROUND
  Subintimal angioplasty is effective in treating peripheral chronic total occlusions (CTO). However, this technique is often limited by the inability to re-enter the true lumen after subintimal crossing of the occluded segment. The Pioneer catheter was the first device to address this difficulty associated with subintimal angioplasty.
  
  
  METHODS
  A retrospective review of 21 consecutive cases of peripheral CTOs requiring use of the Pioneer catheter were reviewed. The patients' demographics, indications for the procedure, location and extent of occlusion, lesion characteristics, technique, procedural success and complications were recorded.
  
  
  RESULTS
  Twenty of 21 cases were procedurally successful (defined as < or = 30% post-procedure stenosis), for a rate of 95%. The most commonly occluded vessels were the common iliac artery and the superficial femoral artery. The average occlusion length was 107 mm (standard deviation = 87) with a range of 23-300 mm. Both antegrade and retrograde approaches were successful. There was only 1 complication in the study population.
  
  
  CONCLUSIONS
  The Pioneer catheter is a re-entry device that is versatile and improves success rates of subintimal angioplasty, which may lead to improvement in the care of patients with CTOs. The cases series demonstrates the use of the Pioneer catheter in treating CTOs.
authors.affiliation: Heart Institute, Good Samaritan Hospital, Los Angeles, California, USA.
authors.forename: Hazim
authors.initials: H
authors.lastname: Al-Ameri
authors.forename: Victoria
authors.initials: V
authors.lastname: Shin
authors.forename: Guy S
authors.initials: GS
authors.lastname: Mayeda
authors.forename: Steven
authors.initials: S
authors.lastname: Burstein
authors.forename: Ray V
authors.initials: RV
authors.lastname: Matthews
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kloner
authors.forename: David M
authors.initials: DM
authors.lastname: Shavelle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods*; D002404:Catheterization; D002406:Catheterization, Peripheral / Q000295:instrumentation / Q000379:methods*; D002908:Chronic Disease; D005260:Female; D005263:Femoral Artery / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D017539:Tunica Intima / Q000473:pathology