Recoil Study Summary
Michael Lichtenberg, MD
Arnsberg Clinic
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Dr. Peter Schneider:
Hello, my name is Peter Schneider, and today we have a special guest, Dr. Michael Lichtenberg from Arnsberg, Germany. We’re going to talk with him about a few important topics. Before we begin, Michael—welcome, and thank you for joining us. Could you tell us a little about yourself?
Dr. Michael Lichtenberg:
Thank you, Peter, for the invitation.
My name is Michael Lichtenberg. I’m from Arnsberg, in the western part of Germany. I’m an interventional angiologist, and I’ve been working in this field for many years. We work in a center where we treat a large number of CLI patients—patients with below-the-knee (BTK) disease. We run three labs and perform a high volume of PTK work, which is why we’re here today.
Dr. Peter Schneider:
Very good—thank you, Michael. And of course, he’s being modest. Every interventionist who treats vascular disease likely knows Michael and his center. They’ve participated in many studies. Today, I wanted to ask you about one of those studies, specifically focused on recoil. Throughout my career, we’ve heard that if you perform balloon angioplasty and don’t get the result you want, it could be due to dissection, residual stenosis, or recoil. Recoil is often mentioned, yet there hasn’t been a great deal of literature on it. That’s why I think people will be excited to hear about your study. To start, can you share your thoughts on recoil—what it is and why it happens?
Dr. Michael Lichtenberg:
Recoil is something we’ve come to better understand in recent years. Unfortunately, it significantly affects our patients, especially when treating BTK disease. We’ve known about recoil from the literature for more than 10 years. There’s a well-known paper by Frank Baumann from Switzerland, published in 2014, which analyzed patients treated with standard balloon angioplasty in BTK lesions. What they observed was immediate recoil—meaning a loss of lumen—within 15 minutes after treatment. It has taken time for this issue to become part of routine clinical consideration, but from my perspective, recoil has a direct impact on patency outcomes. When we perform standard balloon angioplasty in highly calcified BTK vessels, we often see that the lumen we initially gain is partially lost within minutes. This clearly affects outcomes in patients with critical limb ischemia. So it’s very important to focus on this issue. We know that better patency leads to better wound healing and improved amputation prevention. That’s why recoil needs to be addressed.
Dr. Peter Schneider:
So essentially, you’ve got a limb at risk, and within 15 minutes, what you achieved is already diminished—you’ve lost lumen. One of the fundamental principles we learn in vascular medicine is Poiseuille’s law—how flow relates to vessel radius. How do you think recoil impacts flow in the tibial vessels you treat?
Dr. Michael Lichtenberg:
It’s actually quite simple. If you lose lumen, you lose flow to the foot—and that directly affects clinical outcomes. Our goal is to create as much lumen as possible, and more importantly, stable lumen. However, with standard balloon angioplasty, it appears we are not achieving durable lumen gain. This led to the idea of using serration technology. Together with my co–principal investigator, Dr. Venita Chandra from Stanford University, we designed a trial to evaluate whether serration angioplasty could reduce recoil compared to standard balloon angioplasty. As you mentioned, there’s limited literature on recoil. Aside from the 2014 paper, there’s not much available. We felt it was time to demonstrate that recoil is a real and clinically relevant issue.
Dr. Peter Schneider:
In your study comparing POBA to Serranator, what did you find?
Dr. Michael Lichtenberg:
We observed a very impressive difference. The mean recoil across lesions in the POBA group was 55%, compared to only 6% in the Serranator group. This is a highly significant difference. My personal theory is that serration angioplasty increases vessel compliance. By improving compliance, we reduce barotrauma, dissection, residual stenosis, and recoil. Recoil is a major issue immediately after balloon angioplasty, and improving compliance appears to address this.
Dr. Peter Schneider:
Looking at prior research with older angioplasty techniques, nearly all patients experienced recoil. With improved techniques, recoil could be reduced somewhat. Is that correct?
Dr. Michael Lichtenberg:
Yes, that’s correct. Compared to earlier studies like Baumann’s, modern balloon angioplasty techniques do show some improvement in recoil. However, even with optimized, prolonged balloon inflation, we still did not reach the low levels of recoil seen with serration angioplasty. There was a highly significant, core lab–adjudicated difference between the two groups.
Dr. Peter Schneider:
Well, I’d like to thank Dr. Lichtenberg for his time and for his contributions to the field of vascular medicine—especially for these vulnerable patients with critical limb ischemia. Your work is helping to advance new methods, algorithms, and ideas that move the field forward.
Dr. Michael Lichtenberg:
Thank you very much, Peter. I would also like to especially thank Dr. Venita Chandra from Stanford, who was the co–principal investigator of this trial. It was a pleasure working with her and generating these important data.
