European Radiology

, Volume 28, Issue 11, pp 4792–4799 | Cite as

Percutaneous intentional intra-luminal-assisted recanalization (PILAR technique) of challenging chronic total occlusions using a high-frequency vibration device

  • Stephanie VolpiEmail author
  • Amine Chouiter
  • Francois Saucy
  • Steven Hajdu
  • Anne-Marie Jouannic
  • Salah D. Qanadli



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.

Key Points

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.


Peripheral artery disease Endovascular techniques Medical device Angioplasty Lower limb 



Below the knee


Computed tomography angiography


Chronic total occlusion


High-frequency vibrational device


Percutaneous intentional intraluminal-assisted recanalization



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Prof. S.D. Qanadli.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• observational study

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Stephanie Volpi
    • 1
    Email author
  • Amine Chouiter
    • 2
  • Francois Saucy
    • 3
  • Steven Hajdu
    • 1
  • Anne-Marie Jouannic
    • 1
  • Salah D. Qanadli
    • 1
  1. 1.Cardio-Thoracic and Vascular Unit, Department of radiologyCentre Hospitalo-Universitaire VaudoisLausanneSwitzerland
  2. 2.Department of RadiologyHôpital de la ProvidenceNeuchâtelSwitzerland
  3. 3.Department of Vascular SurgeryCentre Hospitalo-Universitaire VaudoisLausanneSwitzerland

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