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BackTable / VI / Podcast / Episode #410
True Lumen Re-Entry with Pioneer Plus
with Dr. Thomas Davis
In this episode of BackTable Podcast, host Dr. Ally Baheti invites interventional cardiologist Dr. Thomas Davis, Director of the Cardiac Catheterization Lab at St. John Hospital and Medical Center, to discuss re-entry devices, with a focus on the Pioneer Plus Catheter.
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BackTable, LLC (Producer). (2024, January 25). Ep. 410 – True Lumen Re-Entry with Pioneer Plus [Audio podcast]. Retrieved from https://www.backtable.com
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Synopsis
Dr. Davis shares his experience in using the Pioneer Plus, an intravascular ultrasound (IVUS) guided re-entry catheter in treating critical limb ischemia (CLI), especially in cases where it is difficult to stay intraluminal. He explains a novel ‘reorientation technique’, which allows proceduralists to remain in the true lumen while treating a chronic total occlusion. Dr. Davis also describes his workflow and decision points about when to reach for the catheter. To finish the episode, he covers post-procedure patient management, imaging follow up, and opportunities to learn more about treatment of peripheral vascular disease.
Timestamps
00:00 - Introduction
02:09 - Dr. Davis’ Practice in CLI Treatment
04:18 - The Decision to Use the Pioneer Plus Catheter
07:31 - The Reorientation Technique for Staying in the True Lumen
11:49 - Using Intravascular Ultrasound to Guide Your Wire
17:33 - Learning and Troubleshooting with IVUS
21:48 - Preparing for Subintimal Work
28:26 - Post-Procedural Management and Imaging
30:12 - Advice for Proceduralists in the CLI Space
Resources
Pioneer Plus Re-Entry Catheter:
https://www.usa.philips.com/healthcare/product/HCIGTDPPLUS/pioneer-plus-ivus-guided-re-entry-catheter
Outback Re-Entry Catheter:
https://cordis.com/na/products/cross/endovascular/outback-elite-re-entry-catheter
Enteer Re-Entry Catheter
https://www.medtronic.com/us-en/healthcare-professionals/products/cardiovascular/chronic-total-occlusion-devices/enteer.html
The Amputation Prevention Symposium (AMP) Meeting:
https://www.hmpglobalevents.com/amptheclimeeting
Transcript Preview
How did you first become acquainted with the Pioneer Plus catheter?
[Dr. Thomas Davis]
The more complex disease states that keep on occurring, we're seeing more and more and more of it, as you know, more total occlusions, multi-level disease being both infrainguinal and infrapopliteal. That in itself inspired me to look for other options to become true luminal and re-enter, certainly out of these total occlusions, out of the subintimal crossings that we had, I would say probably 95% of our cases now at least are CTOs. In many of the cases, you don't stay true luminal, especially for the lengthy lesions. We'll have 20, 30, 40 sonometer lesions that are CTOs so it's very, very difficult to stay intra-luminal. We found the crossing devices work for the most part, but they're very expensive to use. With that, went into using the IVUS-guided reorientation and reentry devices. That's how I got started.
The Materials available on BackTable are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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