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When a coronary lesion won’t open at conventional pressures, what can an ultra-high pressure balloon do differently? On this episode of BackTable Cardiology, host Dr. Hady Lichaa welcomes Dr. Deepak Kapoor, interventional cardiologist at the Medical College of Georgia at Augusta University, to discuss the science, safety, and real-world applications of ultra-high pressure (UHP) balloons in calcified coronary intervention. Dr. Kapoor walks through the evolution of balloon design, the main scenarios where UHP balloons are most useful, and the technical details that set these devices apart from standard non-compliant balloons and other calcium modification tools. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by RADPAD® Radiation Protectionhttps://www.radpad.com/ --- Timestamps 00:00 - Introduction04:00 - Three Key Indications for UHP Balloons05:09 - Balloon Design, Material and Crossing Profile07:32 - Intravascular Imaging and Case Planning11:09 - Wire Compatibility and Buddy Wiring13:55 - Calcium Morphology and Device Selection17:43 - In-Stent Restenosis and Non-Dilatable Stents20:33 - Sizing, Inflation Technique and Indeflators28:21 - Post-Treatment Imaging and Calcium Fracture31:16 - Perforation, Balloon Rupture and Dissection Risk38:03 - Cost and Procedural Control40:20 - Future Calcium Modification Technologies41:37 - Closing Remarks --- More about this episode The conversation covers IVUS-led planning, device selection for different calcium morphologies, inflation strategies, and practical tips to avoid complications like rupture or dissection. Dr. Kapoor shares his approach to in-stent restenosis, cost considerations, and what the future may hold for calcium modification. The conversation closes with advice for operators new to UHP balloons, the importance of post-procedure imaging, and how to stay safe when pushing past traditional pressure limits. --- Resources Very high-pressure dilatation for undilatable coronary lesions: indications and results with a new dedicated balloon (EuroIntervention, 2016)https://pubmed.ncbi.nlm.nih.gov/26111405/ Super high-pressure balloon versus scoring balloon to prepare severely calcified coronary lesions: the ISAR-CALC randomised trial (EuroIntervention, 2021)https://pubmed.ncbi.nlm.nih.gov/33258774/ Safety and efficacy of super-high pressure OPN balloon in patients with in-stent restenosis, an intracoronary imaging-based observational study (Scientific Reports, 2025)https://www.nature.com/articles/s41598-025-20488-7 VICTORY: intravascular lithotripsy versus super-high-pressure balloons in calcified and refractory coronary lesions (PCR, TCT 2025)https://www.pcronline.com/News/Congress-coverages/TCT/2025/VICTORY-Intravascular-lithotripsy-vs.-super-high-pressure-PTCA-in-calcified-and-refractory-coronary-lesions --- BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

As new guidelines redefine risk stratification for pulmonary embolism (PE), emerging technologies are also changing what it means to achieve procedural success. On this episode of the BackTable Podcast, interventional radiologist Dr. Julie Bulman (BIDMC) and interventional cardiologist Dr. Jay Giri (Penn Medicine) join host Dr. Chris Beck to discuss the evolving frameworks and technologies redefining standards for catheter-directed treatment of intermediate- and high-risk PE. They discuss the role of multidisciplinary PERT teams, patient selection, the impact of new thrombectomy devices, and why autologous blood return is a growing consideration for procedural success. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Endovascular Engineering (E2)E2Helo.com --- Timestamps 00:00 - Introduction03:42 - Referral Patterns and PERT Scope05:25 - PE Workup Essentials07:26 - Targeted Assessment of Acuity11:36 - Reliability of the Walk Test14:35 - PE Treatment Pathways19:26 - Procedural Walkthrough24:15 - Catheter Sizing30:05 - Adjunct Aspiration Device Features35:09 - Blood Return Process and Safety40:03 - Helo Study Early Results45:09 - Determining Procedural Endpoints50:20 - Future Trials and Technologies53:48 - Final Thoughts and Closing Remarks --- More about this episode The discussion highlights how PERT teams use updated guidelines and thorough clinical evaluation to guide patient classification and treatment pathway selection. Dr. Bulman and Dr. Giri outline their criteria for choosing anticoagulation, catheter-directed lysis, or mechanical clot removal, and compare the techniques and learning curves for medium- versus large-bore thrombectomy devices. They explore the significance of autologous blood return during aspiration thrombectomy, noting how new reinfusion systems can reduce blood loss and influence procedural decision-making. Dr. Bulman also presents early Helo Thrombectomy System study data demonstrating the benefits of mechanized aspiration with minimal complications. The episode closes with a critical look at defining true functional procedural endpoints beyond pulmonary arterial pressures and offers a preview of upcoming trial data, such as HI-PEITHO and PEERLESS II, that could further advance PE management. --- Resources 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adultshttps://doi.org/10.1161/CIR.0000000000001415 Ultrasound-Facilitated, Catheter-Directed Thrombolysis in Intermediate-High Risk Pulmonary Embolism (HI-PEITHO)https://clinicaltrials.gov/study/NCT04790370 PEERLESS II studyhttps://clinicaltrials.gov/study/NCT06055920 Catheter-Directed Thrombolysis in Intermediate-High–Risk Pulmonary Embolism (PRAGUE-26)https://doi.org/10.1056/nejmoa2608012 Pulmonary Embolism International THrOmbolysis Study-3 (PEITHO-3)https://clinicaltrials.gov/study/NCT04430569 --- BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

What are the critical steps for delivering a stent in tortuous, calcified coronary lesions, and how do you adapt when the anatomy fights back? This week on the BackTable Cardiology Podcast, Dr. Hady Lichaa hosts interventional cardiologist Dr. Sripal Bangalore, director of the Cath Lab and CTO program at Bellevue Hospital, to discuss planning and performing complex percutaneous coronary intervention (PCI). Their conversation centers on advanced strategies for retroflex circumflex lesions approached via right radial access, with a focus on careful angiogram review, managing severe tortuosity, and post-procedure antithrombotic regimens. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported byTeleflexhttps://www.teleflex.com/ --- Timestamps 00:00 - Introduction02:21 - Pre-PCI Case Planning07:23 - Wires And Tracking Tricks11:22 - Guide Extensions Masterclass16:58 - Dampening And Safe Injection20:19 - Calcified Lesion Escalation26:55 - Stent Selection And ORSIRO31:03 - Post-Procedure DAPT Strategy37:38 - Perforation Rescue Playbook44:28 - Conclusion --- More about this episode Dr. Bangalore offers tips for advancing through obtuse angles, expediting PCI when guide pressure dampens, and pivoting when challenges arise. He shares experience-driven advice on early use of guide extensions, best practices for avoiding hydraulic dissection, and escalation strategies for calcified lesions. The episode also covers stent selection, managing leaks after covered stent deployment, and the importance of intravascular imaging guidance and minimizing triple therapy duration. Dr. Bangalore closes with pearls for new operators and emphasizes that in complex interventions, adaptability and imaging are key. --- Resources Dr. Sripal Bangalore’s Physician Profilehttps://nyulangone.org/doctors/1902066871/sripal-bangalore Dr. Hady Lichaa’s Physician Profilehttps://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa The Elusive Late Benefit of Biodegradable Polymer Drug-Eluting Stentshttps://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.038378?doi=10.1161/CIRCULATIONAHA.118.038378 --- BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

How are new aspiration thrombectomy systems and real-time hemodynamic monitoring enabling safer, more effective pulmonary embolism treatment? On this episode of the BackTable Podcast, Dr. Ally Baheti welcomes Dr. Maya Serhal and Dr. David Dexter for a deep dive into modern pulmonary embolism (PE) management, with a focus on advances in large-bore aspiration thrombectomy. They discuss evolving PE triage algorithms, real-world procedural strategies, and the clinical impact of next-generation aspiration systems on safety, efficiency, and patient recovery. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported byImperative Care https://www.imperativecare.com/ --- Timestamps00:00 - Introduction02:03 - PE Response Workflow05:32 - Symphony Device07:07 - Sizing and Blood Loss10:00 - Multi-Port Hemodynamics14:45 - Procedure Endpoints17:01 - IVUS Guided Strategy20:02 - ProHelix and Lollipopping25:48 - Case Studies34:12 - Closing Thoughts --- More about this episodeThe conversation explores multidisciplinary PE response workflows, lab and imaging triggers for escalation, and technical considerations in catheter sizing, blood loss management, and real-time hemodynamic monitoring. Dr. Dexter reviews his use of intravascular ultrasound for precise clot localization, and Dr. Serhal shares practical tips for adjusting aspiration power to avoid complications. Together, they discuss procedural endpoints, mechanical assist devices for difficult clots, and present case examples demonstrating rapid improvement in hemodynamics and oxygenation. The episode emphasizes the importance of teamwork, patient selection, and ongoing innovation in optimizing PE care. --- Resources American Society of Hematology 2020 Guidelines for Management of Venous Thromboembolism: Treatment of Deep Vein Thrombosis and Pulmonary Embolismhttps://ashpublications.org/bloodadvances/article/4/19/4693/463998/American-Society-of-Hematology-2020-Guidelines-for Prospective Multicenter IDE Study of the Next-Generation Precision Aspiration Thrombectomy System for Intermediate-Risk Pulmonary Embolism: The SYMPHONY-PE Trial https://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.125.015815 Is There a Golden Hour for Thrombectomy in Intermediate-Risk Pulmonary Embolism? Insights From SYMPHONY-PEhttps://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.126.016573 --- BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.► https://www.backtable.com/app

Once your PERT is assembled, how do you navigate the evolving pulmonary embolism (PE) literature to improve patient outcomes at all risk levels? In this episode of the BackTable Podcast, interventional radiologist Dr. Robert Lookstein (Mount Sinai) and pulmonary critical care specialist Dr. Timothy Fernandes (UC San Diego) join host Dr. Harris Chengazi to examine the latest evidence and multidisciplinary strategies for managing acute pulmonary embolism. The discussion highlights the complexities of catheter-directed therapies in intermediate- to high-risk PE, evolving guidelines in the face of new trial data, and prioritization of improving patients’ clinical trajectories. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported byPenumbrahttps://www.penumbrainc.com/ --- Timestamps00:00 - Introduction03:57 - PERT Structure and Activation08:24 - PE Risk Stratification Tools12:02 - Patient Selection for IR Intervention15:21 - Assessing Clot Chronicity21:03 - Standardizing Workup26:38 - Managing Unstable PE28:31 - STORM-PE and HI-PEITHO Trial Data35:49 - Guidelines vs. New Evidence40:12 - Determining Therapeutic Endpoints45:05 - Upcoming Trials and Future Directions51:46 - Final Thoughts and Closing Remarks --- More about this episodeThe physicians explore the nuances of validated PE risk stratification tools, assessing the relationship between various PE scoring systems and the 2026 ACC/AHA classification for acute PE. They emphasize that the integration of clinical assessment, serial lab work, and patient history must take precedence over static imaging alone in guiding care. The doctors go on to review new trial data, including the improved RV-to-LV ratio and 90-day functional gains seen with mechanical thrombectomy in STORM-PE and reduced clinical deterioration observed with ultrasound-assisted catheter-directed thrombolysis in HI-PEITHO. The conversation concludes with a call for collaborative, safety-first management that focuses on the patient’s clinical status and long-term post-PE functional recovery. --- Resources 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adultshttps://doi.org/10.1161/CIR.0000000000001415 Composite Pulmonary Embolism Shock (CPES) Scorehttps://doi.org/10.1161/CIRCINTERVENTIONS.124.014088 FOCUS studyhttps://doi.org/10.1093/eurheartj/ehac206 STORM-PE trialhttps://doi.org/10.1161/CIRCULATIONAHA.125.077232 HI-PEITHO trialhttps://doi.org/10.1056/nejmoa2516567 PE-TRACT studyhttps://petractstudy.org/homepage PEERLESS II studyhttps://clinicaltrials.gov/study/NCT06055920 PERSEVERE trialhttps://clinicaltrials.gov/study/NCT06588634 --- BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.► https://www.backtable.com/app

How do you decide between a dedicated aortic scaffold and kissing stents in complex aortoiliac bifurcations? On this episode of the BackTable Podcast, Dr. Sabeen Dhand and Dr. Eric Secemsky discuss the management of a female smoker presenting with rapidly progressive bilateral hip pain, ultimately revealed to be severe aortoiliac arterial disease. The case highlights the value of noninvasive vascular studies, CTA, and IVUS for precise diagnosis and procedural planning, as well as the nuanced decision-making process between different device options. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction01:56 - Patient History05:42 - CTA and Angio Findings09:30 - Strategy Access and IVUS13:17 - IVUS Sizing and Lesion Review16:38 - IVL Angioplasty Technique18:28 - Stenting and Final Result22:50 - Post-procedure Meds and Outcome24:34 - Wrap Up --- More about this episode Dr. Secemsky reviews access strategy, lesion sizing, and the use of intravascular lithotripsy to reduce rupture risk in heavily calcified arteries. The doctors explain their rationale for choosing kissing covered stents over a dedicated aortic scaffold, details the technical steps of ballooning and stenting, and discusses the transition from dual antiplatelet therapy to rivaroxaban and aspirin postprocedure. The episode concludes with key insights into device selection, procedural technique, and patient-centered decision-making for successful aortoiliac interventions. --- BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

How can transcaval access transform options for patients with challenging vascular anatomy undergoing TAVR and other cardiac procedures? On this episode of the BackTable Cardiology Podcast, host Dr. Hady Lichaa interviews Dr. Pedro Villablanca, a structural interventionalist at Henry Ford Hospital, about the expanding role of transcaval techniques. They discuss how transcaval access leverages the IVC and aorta to bypass small or diseased vessels, offering transfemoral-like ergonomics, conscious sedation, and less radiation exposure for carefully selected patients. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction02:35 - What Is Transcaval Access?09:34 - Crossing Site Measurements17:17 - Step-by-Step Procedure20:26 - Electrosurgery Setup28:04 - Troubleshooting Scenarios34:36 - Lost Wire Recovery39:19 - Balloon Tamponade Planning44:00 - Step-by-Step Closure53:31 - Hydration and Hemoglobin01:00:42 - Training and Proctorship01:04:42 - Conclusion --- More about this episode The conversation offers a step-by-step walkthrough of transcaval TAVR, covering pre-procedural planning with CT and fluoroscopy, device selection, and troubleshooting for complications like lost wires and bleeding. Dr. Villablanca details closure strategies, balloon tamponade, and the use of cover stents as bailouts. They discuss the importance of multidisciplinary planning, anatomic considerations, and practical pearls from real cases. The episode closes with advice for operators new to transcaval access and emphasizes the value of preparation, collaboration, and continuous learning in mastering this advanced technique. --- Resources Dr. Hady Lichaa Physician Profilehttps://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa Dr. Pedro Villablanca Physician Profilehttps://www.henryford.com/physician-directory/v/villablanca-spinetto-pedro SCAI Structural Heart Disease Courseshttps://www.scai.org/clinical-practice/structural --- BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Can independent private practice offer greater efficiency, better patient care, and a more balanced physician lifestyle? On this episode of the BackTable Cardiology Podcast, host Dr. Hady Lichaa talks with Dr. Jon George about his journey from academic cath lab leadership to launching an ambulatory surgery center and thriving as a solo practitioner. They discuss the business, regulatory, and clinical realities of building a modern private practice in today’s changing healthcare environment. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction02:51 - Private Practice Landscape05:17 - Pendulum Swing to Independent Practice10:04 - Making the Move to Solo Practice15:24 - Training and Research Beyond Hospitals17:55 - MBA and Business Skills20:02 - Building a Broad Practice23:35 - Income, Ownership, and Mindset Shifts27:28 - Administrative Load and Management Help32:35 - Launching the ASC Cath Lab38:24 - Boosting Efficiency, Lifestyle, and Preventing Burnout43:17 - Advice for Fellows48:15 - Call Coverage and Negotiation49:52 - Closing Reflections and Takeaways --- More about this episode Dr. George shares how his frustrations with hospital financial transparency, procedural limitations, and the pandemic’s impact on patient willingness to come to hospitals motivated his transition to a solo practice in 2020. He explains why only about 30 percent of U.S. cardiologists remain independent, highlighting the shift toward lower-cost outpatient sites, recent CMS approvals for more ASC procedures, and state differences in certificate-of-need laws. Dr. George discusses strategies for scaling through hospital affiliations, negotiating teaching and research support, and partnering with management companies to streamline operations. He also describes building a state-of-the-art cath lab and imaging center, improving efficiency and physician lifestyle, and offers a practical five-question framework for clinicians considering the move to private practice. --- Resources ReVaMP Heart and Vascular Institutehttps://www.revascmed.com/ University of Cincinnati Ohio College of Medicinehttps://med.uc.edu/ University Hospitals Case Medical Centerhttps://www.uhhospitals.org/locations/uh-cleveland-medical-center Temple University Hospital https://www.templehealth.org/locations/temple-university-hospital --- BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

What are the real-world challenges and rewards of running an ambulatory surgery center (ASC)? On this episode of BackTable Cardiology, host Dr. Hady Lichaa interviews Dr. Fadi Saab about his transition from an outpatient-based lab (OBL) to an ASC, focusing on business, regulatory, and clinical considerations that go beyond procedural technique. They discuss how rising healthcare costs are driving ASC expansion, the benefits of improved patient experience, efficiency, convenience, and physician autonomy, as well as concerns about private equity influence and systemic pressures to shift cases out of hospitals. ---Get the BackTable apphttps://www.backtable.com/app --- Timestamps00:00 - Introduction 03:10 - Why ASCs Are Expanding 05:36 - Autonomy, Efficiency, and Key Concerns10:43 - Ensuring Safety and Outcomes14:07 - OEIS Registry and Certification17:02 - Managing Complications and Transfers22:36 - EP Procedures in the Outpatient Setting 27:09 - OBLs Under Pressure34:43 - Reimbursement Challenges and Burnout39:22 - Business Skills and Consultants44:07 - Income Reality and Partnerships50:12 - Reflection on the Transition55:46 - Closing Thoughts and Advice --- More about this episodeDr. Saab outlines critical safety oversight measures including state regulations, registry reporting, transfer agreements, ACLS-trained teams, and peer review. He shares data showing that PCI outcomes in ASCs are comparable to those in outpatient hospitals, and reviews the expansion of electrophysiology procedures into ASCs enabled by CMS codes. The conversation highlights infrastructure needs, differences in OBL versus ASC reimbursement, and the importance of hiring experienced leaders and consultants. Dr. Saab provides practical advice on partnering with like-minded physicians, understanding Stark and anti-kickback rules, and setting realistic expectations for profitability, which may take 18 to 30 months. The episode closes with reflections on mentorship, operational excellence, and how ASCs are adapting to the changing landscape of cardiovascular care. --- ResourcesInterventional Cardiologists' Perspectives on Percutaneous Coronary Intervention at Ambulatory Surgical Centershttps://pubmed.ncbi.nlm.nih.gov/41088884/ OEIShttps://oeisweb.com/ Administrative Expenses In The US Health Care System https://jamanetwork.com/journals/jama/fullarticle/2785479#google_vignette --- BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.► https://www.backtable.com/app

What separates a good medical practice from one that consistently delivers exceptional patient care and retains dedicated team members? On this episode of BackTable Cardiology, Dr. Ankit Patel explores this with Dr. Craig Walker of Cardiovascular Institute of the South. Dr. Walker shares how his journey from rural Louisiana to Harvard shaped his approach to building a mission-driven, patient-centered cardiology practice. He discusses the impact of early lifesaving experiences, the value of compassionate communication, and how a clear mission has guided the practice’s growth and lasting impact. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction04:54 - Training And Early Career07:38 - Mission Statement: TRECC10:53 - The Impact of Mentorship13:09 - Why Start NCH Meetings?17:02 - Developing a Practice21:35 - Workflow And Team Culture26:33 - Training The Next Generation32:16 - Venous Disease Gap40:40 - Goals Mission Mindset45:37 - Advice For Trainees54:17 - Conclusion --- More about this episode The conversation dives into the operational strategies that have driven the growth of Cardiovascular Institute of the South, from developing a mission statement focused on technology, research, education, communication, and compassion to building a culture of mentorship and continuous learning. Dr. Walker and Dr. Patel discuss how goal-setting and team engagement have fueled expansion to multiple sites and fostered ongoing clinical innovation. They also highlight the importance of training the next generation, founding New Cardiovascular Horizons meetings to advance peripheral vascular care, and maintaining excitement in medicine by always prioritizing patient needs and collaborative leadership. --- Resources Dr. Craig Walker’s Physician Profilehttps://www.cardio.com/team/craig-walker’-md/ Dr. Ankit Patel’s Physician Profilehttps://www.getcare.hackensackmeridianhealth.org/provider/ankitkumar-kirankumar-patel/1316247 New Cardiovascular Horizonshttps://ncvh.org/ Temporary Occlusion Embolectomy: A Cost-Effective Approach to Distal Embolic Protection in Peripheral Artery Diseasehttps://www.hmpgloballearningnetwork.com/site/vdm/case-series/temporary-occlusion-embolectomy-toe-cost-effective-approach-distal-embolic --- BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

When should you keep pushing and when should you walk away during a tough chronic total occlusion (CTO) case with heavy coronary calcification? On this episode of BackTable Cardiology, coronary CTO expert Dr. Kate Kearney from the University of Washington joins Dr. Hady Lichaa to define what makes a coronary PCI truly complex and to break down real-world strategies for managing ambiguous, heavily calcified lesions. The discussion emphasizes the uncertainty of achieving a good outcome and highlights the critical role of troubleshooting and dynamic decision-making in the cath lab. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Sponsorhttps://shockwavemedical.com/ --- Timestamps 00:00 - Introduction04:48 - Hard CTO Case Insights 08:43 - CTO vs IVL Safety And Predictability15:18 - Atherectomy Lesion Length for Atherectomy23:13 - Interpreting Calcium on Imaging 27:58 - D-Shaped Stents after Calcium Modification30:19 - Left Main Bifurcation Strategy35:31 - IVL Versus Atherectomy Sequencing39:49 - When To Stop A Case50:28 - Future Of IVL And Imaging53:47 - Conclusion --- More about this episode Dr. Kearney shares practical strategies developed through real CTO case experience, including when to deploy dynamic stop-or-continue decision-making and how to leverage “phone a friend” safety rules for complex cases. She explains how intravascular lithotripsy (IVL) has made balloon-based calcium modification more predictable, improved stent results, and encouraged a multimodal approach, while early atherectomy still plays a role for deliverability and control. The discussion also covers imaging-driven criteria for intervention, D-shaped stent placement, and tailored planning for left main bifurcation or ostial circumflex lesions, highlighting the value of collaborative and evidence-based practice in advanced coronary intervention. --- Resources Dr. Hady Lichaa Physician Profile: https://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa Dr. Kate Kearny Physician Profile:https://www.uwmedicine.org/bios/kathleen-kearney ECLIPSE trial:https://www.acc.org/latest-in-cardiology/clinical-trials/2024/10/25/04/32/eclipse Shockwave Lithoplasty Compared to Cutting Balloon Treatment in Calcified Coronary Disease (Short-Cut Trial): https://clinicaltrials.gov/study/NCT06089135 --- BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

What is the emerging role of bioresorbable scaffolds in treating tibial artery disease, and how do they compare with traditional stenting and drug delivery approaches? In this episode of the BackTable Podcast, Dr. Sabeen Dhand interviews interventional cardiologist Dr. Sahil Parikh at Columbia to explore the evolution of tibial artery stenting, drug-eluting technology, and the latest evidence behind bioresorbable scaffolds. The discussion highlights patient selection, treatment algorithms, technical considerations, and the impact of drug delivery choices on patient outcomes. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Abbott https://www.cardiovascular.abbott/us/en/hcp/products/peripheral-intervention/esprit-btk-resorbable-scaffold-system.html --- Timestamps 00:00 - Introduction04:00 - Bioengineering Origins08:29 - Paclitaxel vs. Limus 13:43 - When to Stent Tibials 16:14 - Stepwise Tibial Algorithm 18:46 - Stent Platforms and Costs 23:09 - Bifurcation Stenting Basics 26:35 - Fracture and Crush Risks 30:10 - Device Selection: Born for Tibials 33:27 - Materials and Drug Kinetics 36:57 - How to Deploy Safely 40:46 - Cost and Reimbursement Reality 43:21 - Market Growth and Competitors 48:02 - Paclitaxel Mortality Scare 51:13 - Final Takeaways and Access --- More about this episode Dr. Parikh reviews the differences between paclitaxel and sirolimus or limus agents, the historical dominance of paclitaxel in peripheral devices, and why peripheral therapy has lagged behind coronary interventions. He outlines a practical tibial treatment algorithm emphasizing crossing (often with retrograde access), imaging to assess calcium, lesion preparation (including IVL, specialty balloons, and atherectomy when needed), proper sizing, and bailout stenting for recoil or dissection, and addresses the unique challenges of distal placement, bifurcations, and occasional fractures. The discussion covers the evolution and rationale, absorption timeline, and clinical data for bioresorbable scaffolds, as well as reimbursement, emerging alternatives, and the ongoing debate over paclitaxel safety. Dr. Parikh also shares his perspective on the future of drug delivery, the need for payer support, and strategies for ensuring the best patient care across diverse clinical settings. --- Resources US Esprit™ BTK System Product Information (https://www.cardiovascular.abbott/us/en/hcp/products/peripheral-intervention/esprit-btk-resorbable-scaffold-system.html?utm_medium=podcast&utm_source=backtable&utm_campaign=us-endo-esprit-btk&utm_division=vas&utm_product=esprit-btk&utm_content=kol&utm_type=other) US Esprit™ BTK System Important Safety Information (https://www.cardiovascular.abbott/us/en/hcp/products/peripheral-intervention/esprit-btk-resorbable-scaffold-system/important-safety-information.html) Drug-Eluting Resorbable Scaffold versus Angioplasty for Infrapopliteal Artery Disease(https://pubmed.ncbi.nlm.nih.gov/37888915/) --- BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Slow is smooth, smooth is fast, and that’s true for carotid artery stenting too. In this episode of the BackTable Cardiology Podcast, Dr. Hady Lichaa welcomes Dr. Navneet Sharma to discuss practical tips for carotid artery stenting, including can’t-skip pre-procedure imaging, minimizing aortic arch manipulation, and how a healthy dose of patience helps catheter advancement more than you might think. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction01:59 - Complex Case Walkthrough09:47 - Preprocedure Workup16:31 - Femoral Catheter Playbook24:18 - Embolic Protection Strategy26:12 - Step By Step Stenting Walkthrough34:38 - Antiplatelet Checklist48:18 - Tortuosity and Arch Tips52:12 - Calcified Access Solutions59:42 - Wrap up and Credits --- More about this episode Through notable case examples and common procedural dilemmas, Dr. Sharma explains how anatomy and clinical risk guide patient selection, the choice between radial and femoral access, and a step-by-step guidewire technique. The discussion also explores optimal anticoagulation regimens, advances in embolic protection, and technical solutions for challenging cases like tortuosity and calcified access. Drs. Lichaa and Sharma highlight the importance of teamwork in carotid interventions and share career development advice for operators looking to refine their skills in this evolving field. --- Resources Dr. Hady Lichaa’s physician profile:https://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa Dr. Navneet Sharma’s physician profile:https://providers.clevelandclinic.org/provider/navneet-sharma/4268293 Medical Management and Revascularization for Asymptomatic Carotid Stenosis (CREST-2)https://www.nejm.org/doi/full/10.1056/NEJMoa2508800 Transcranial Duplex Evaluation of Internal Carotid Artery Flow Direction during Transcarotid Artery Revascularisation with Integrated Embolic Protectionhttps://www.ejves.com/article/S1078-5884(25)00116-9/fulltext --- BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Is it time to move beyond RV pacing and rethink the future of TAVR procedures with dedicated LV pacing strategies? In this episode of BackTable Cardiology, host Stephanie Younes talks with Dr. Jeff Southard, interventional cardiologist at UC Davis, about the evolution of left ventricular (LV) pacing and its impact on TAVR workflow. They discuss the limitations of earlier off-the-shelf LV pacing methods, the reasons for relying on RV pacing in the past, and how a shift to dedicated LV pacing wires is changing daily practice for both balloon-expandable and self-expanding valves. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Merit Medicalhttps://www.merit.com/product/solopace-fusion-system/ --- Timestamps 00:00 - Introduction02:27 - Early LV Pacing Skepticism06:08 - Backup Strategy and Capture Test08:02 - Step by Step TAVR Workflow12:32 - Reasons for Slow Adoption14:04 - Wire Design and Iterations15:55 - Sheath Support in Tough Anatomy16:57 - Avoiding Aortic Scrape Risks18:08 - Staffing and Table Roles20:51 - Beyond TAVR Use21:58 - Device Design and Reliability24:16 - EZ-TAVI Data Breakdown27:28 - Algorithms vs. RV Pacing29:17 - Purpose Built LV Pacing Wrap Up30:25 - Wrap Up and Credits --- More about this episode Dr. Southard details how his team’s adoption of a dedicated LV pacing wire improved reliability, reduced the need for venous access, and helped eliminate RV pacing-wire complications. He explains how this approach has saved time, streamlined staffing by moving pacing control to the sterile table, and minimized procedural steps. The conversation covers patient selection, exceptions for those at higher risk of heart block, technical pearls, and recent data from the EZ-TAVI trial. They also highlight the clinical significance of multi-point LV endocardial contact and adaptive algorithms for maintaining capture during TAVR procedures. --- Resources TAVR Trialhttps://pubmed.ncbi.nlm.nih.gov/31857014/ SoloPACEhttps://www.solopace.health/ Dr. Jeffrey Southard UC Davishttps://health.ucdavis.edu/medical-center/team/1170/jeffrey-southard---cardiology---cardiovascular-medicine---interventional-cardiology---internal-medicine-sacramento/ --- BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Can cardiac CTA take the guesswork out of complex CTO (chronic total occlusion) procedures? In this episode of Backtable Cardiology, host Dr. Hady Lichaa interviews interventional cardiologist and CTO operator Dr. Anbukarasi Maran about how advanced CT imaging is changing the landscape of CTO PCI (percutaneous coronary intervention) planning. They discuss workflow for integrating photon-counting CT, collaboration with radiologists, and why this approach is being adopted for pre-procedure planning in CTO cases, reflecting its growing use in structural heart interventions. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction03:04 - Why CTA for CTO05:24 - CTA Workflow and Photon Counting07:15 - Key CTA Findings for Strategy12:12 - In Lab CTA Overlay Case Example15:20 - Planning for All Operators17:07 - Guide Selection and Efficiency18:23 - Reading CTA and Teamwork22:46 - Photon Counting for Stents24:01 - Limitations Kidney Rate BMI31:13 - Building a CTA Program33:26 - Wrap Up and Credits --- More about this episode Dr. Maran describes a workflow using photon-counting CT, when available, to reduce calcium blooming and to better assess plaque and stents. She emphasizes close collaboration with radiologists for 3D reconstruction, vessel course mapping, calcification patterns, landing zones, collateral selection, and resolving proximal cap ambiguity. Dr. Maran notes that CTA can reduce repeat diagnostic catheterizations, improve time efficiency, guide device selection, and help anticipate the need for calcium-modifying tools, while not replacing intravascular imaging. Limitations discussed include renal function (avoiding CTA when creatinine is greater than two), occasional misleading findings in heavy calcium, heart-rate control challenges, and high BMI affecting image quality. She advises launching programs through multidisciplinary champions, administrative value framing, and careful reimbursement planning. --- Resources Dr. Anbukarasi Maranhttps://www.getcare.muschealth.org/providers/anbukarasi-maran-1861579112 --- BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app