title: Pioneer re-entry device for iliac chronic total occlusion: truly a paradigm shift.
abstract: The number of percutaneous revascularization procedures performed for symptomatic peripheral arterial disease has significantly increased over the past several years. Traditionally, the use of percutaneous techniques were limited to certain anatomic subsets, such as stenosis or focal occlusions, with surgical treatment preferred for more extensive disease. More recently, endovascular specialists are facing the challenge of peripheral chronic total occlusions. Furthermore, unlike the coronary circulation, these occlusions are often very long and associated with other features of complexity such as severe calcifications. One of the primary issues concerning these lesions is the ability to safely achieve initial angiographic success. This article focus indeed on the Pioneer catheter, a new lumen re-entry device exploiting intravascular ultrasound imaging that was used in a case of totally occluded left common iliac artery with favorable results. The details of this technique, and how this catheter helped in re-entering the true lumen at the aortic bifurcation after subintimal dissection, are thoroughly discussed.
authors.affiliation: Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy; Department of Cardiology, Ain Shams University, Cairo, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Rezq
authors.forename: Alessandro
authors.initials: A
authors.lastname: Aprile
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sangiorgi
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D002908:Chronic Disease; D003251:Constriction, Pathologic; D004867:Equipment Design; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D008297:Male; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000628:therapy*; D011859:Radiography; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D062666:Vascular Access Devices