BackTable Cardiology

Renal denervation is back in the guidelines, but what does the latest evidence mean for patient selection, technique, and counseling in the cath lab? On this episode of BackTable Cardiology, Dr. Vladimir Lakhter interviews Dr. Dmitriy Feldman, director of endovascular services in the Division of Cardiology at Weill Cornell Medicine, about where renal denervation fits in hypertension care today. They cover the new guideline recommendation, the history behind the procedure's comeback, the referral pathway and pre-procedural workup, and how to counsel patients on what to expect.

---

Get the BackTable app
https://www.backtable.com/app

---

Timestamps

00:00 - Introduction
02:42 - Guideline Recommendations for Renal Denervation
05:36 - Lessons From Early Sham-Controlled Trials
12:15 - Referral Pathways and Hypertension Programs
17:16 - Pre-Procedural Workup and Imaging
23:11 - Patient Selection and Counseling
29:09 - Durability of Blood Pressure Reduction
31:46 - Radiofrequency Denervation Technique
42:44 - Ultrasound Denervation Technique
45:38 - Sedation and Pain Management
49:06 - Complication Management
53:10 - Future Directions in Denervation
58:05 - Closing Remarks

---

More about this episode

Dr. Feldman, a co-author of the 2023 SCAI position statement on renal denervation, explains why the first large sham-controlled trial missed its primary endpoint and how off-medication trials, ambulatory blood pressure endpoints, and multielectrode catheters changed the picture. He then walks through the procedure itself: CT angiography for anatomic screening, vessel sizing for radiofrequency ablation of the main renal arteries and their branches, wire selection for tortuous anatomy, how the ultrasound balloon system differs, sedation for a painful procedure, and preparation for rare complications. He also shares why he tells patients that renal denervation is not a cure but a one-time treatment with a long-term effect. The episode closes with a look at what may come next, from nerve stimulation and multi-organ denervation to possible metabolic and rhythm benefits, and why hypertension deserves a central place in cardiovascular prevention.

---

Resources

Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension. 2025
https://doi.org/10.1161/HYP.0000000000000249

Position Statement on Renal Denervation for Hypertension: Patient Selection, Operator Competence, Training and Techniques, and Organizational Recommendations. JSCAI. 2023
https://doi.org/10.1016/j.jscai.2023.101121

A Controlled Trial of Renal Denervation for Resistant Hypertension (SYMPLICITY HTN-3). N Engl J Med. 2014
https://doi.org/10.1056/NEJMoa1402670

Efficacy of Catheter-Based Renal Denervation in the Absence of Antihypertensive Medications (SPYRAL HTN-OFF MED Pivotal). Lancet. 2020
https://doi.org/10.1016/S0140-6736(20)30554-7

Long-Term Efficacy and Safety of Renal Denervation in the Presence of Antihypertensive Drugs (SPYRAL HTN-ON MED). Lancet. 2022
https://doi.org/10.1016/S0140-6736(22)00455-X

Endovascular Ultrasound Renal Denervation to Treat Hypertension (RADIANCE II). JAMA. 2023
https://doi.org/10.1001/jama.2023.0713

A Three-Arm Randomized Trial of Different Renal Denervation Devices and Techniques in Patients With Resistant Hypertension (RADIOSOUND-HTN). Circulation. 2019
https://doi.org/10.1161/CIRCULATIONAHA.118.037654

American Heart Association. Hypertension Center Certification
https://www.heart.org/HypertensionCertification

BackTable Cardiology: Renal Denervation: Innovations in Hypertension Management
https://www.backtable.com/shows/cardiology/podcasts/26/renal-denervation-innovations-in-hypertension-management

Dr. Dmitriy Feldman, Weill Cornell Medicine
https://weillcornell.org/dnfeldman

Dr. Vladimir Lakhter, BackTable contributor page
https://www.backtable.com/shows/cardiology/contributors/dr-vladimir-lakhter

---

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

Drug-coated balloons and a head-to-head trial against lithotripsy have put cutting and scoring balloons back at the center of complex percutaneous coronary intervention (PCI). On this episode of BackTable Cardiology, Dr. Nyal Borges interviews Dr. Ziad Ali, director of the DeMatteis Cardiovascular Institute, for an in-depth look at the mechanics, selection, and technique behind cutting and scoring balloons in complex PCI. They cover how these devices create a controlled dissection in fibrolipidic plaque, why they only fracture calcium that sits right at the lumen, and how lesion type and imaging should guide the choice between a conventional balloon, a specialty balloon and intravascular lithotripsy.

---

Get the BackTable app
https://www.backtable.com/app

---

Timestamps

00:00 - Introduction
02:30 - Mechanism of Cutting and Scoring Balloons
06:13 - Superficial Calcium and Balloon Undersizing
08:39 - Focal Force and Calcium Fracture
11:35 - Device Selection and Lesion Length
15:46 - In-Stent Restenosis, Drug-Coated Balloons and Ostial Lesions
19:52 - Procedural Sequence and Balloon Sizing
24:18 - Sizing Without Imaging and Multiple Inflations
26:43 - Enhanced Stent Visualization as a Procedural Endpoint
29:29 - Complications and Branch Vessel Safety
33:14 - Hematoma Fenestration in Dissection and SCAD
37:30 - Take-Home Points and Closing Remarks

---

More about this episode

Dr. Ali shares why he deliberately undersizes balloons for calcified lesions so the blades, not the balloon, do the work, and why a specialty balloon should be the first device for in-stent restenosis. The conversation covers patient and lesion selection, procedural sequence, imaging strategies, and practical safety pearls. They discuss how to size and position the balloon, when to avoid branch vessels, and why enhanced stent visualization, not angiographic appearance alone, tells you when the lesion is prepared. The episode closes with Dr. Ali’s take-home advice: do not fear specialty balloons, match your strategy to your goal, and use imaging to tailor your approach to each patient.

---

Resources

Cutting Balloon to Optimize Predilation for Stent Implantation: The COPS Randomized Trial. Catheter Cardiovasc Interv. 2023
https://doi.org/10.1002/ccd.30603

PREDICTION: Randomized Trial of Cutting Balloon Versus Conventional Balloon Predilation in Severely Calcified Coronary Lesions (jRCT trial record)
https://jrct.mhlw.go.jp/latest-detail/jRCTs052200044

ShortCUT: Randomized Trial of Intravascular Lithotripsy Versus Cutting Balloon in Calcified Coronary Disease (trial record)
https://clinicaltrials.gov/study/NCT06089135
Intravascular Ultrasound-Derived Calcium Score to Predict Stent Expansion in Severely Calcified Lesions. Circ Cardiovasc Interv. 2021
https://doi.org/10.1161/CIRCINTERVENTIONS.120.010296

A New Optical Coherence Tomography-Based Calcium Scoring System to Predict Stent Underexpansion. EuroIntervention. 2018
https://doi.org/10.4244/EIJ-D-17-00962

BackTable Cardiology Episode 14. COSIRA II: Refractory Angina Challenges & Treatment Strategies, with Dr. Ziad Ali
https://www.backtable.com/shows/cardiology/podcasts/14/cosira-ii-refractory-angina-challenges-treatment-strategies

Dr. Ziad Ali, Catholic Health physician profile
https://doctors.catholichealthli.org/provider/ziad-anwar-ali/2404986

Dr. Nyal Borges, Atrium Health physician profile
https://atriumhealth.org/provider-profile/nyal-borges-1790042448

---

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 does it actually take to open a chronically occluded pulmonary artery without pushing the patient into reperfusion pulmonary edema? On this episode of BackTable Cardiology, Dr. Hady Lichaa interviews Dr. Riyaz Bashir, interventional cardiologist and vascular medicine specialist at Mayo Clinic in Jacksonville, about the real-world, table-side technique of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension (CTEPH). They walk through vascular access, telescoping sheath setup, right heart catheterization, pressure wire guidance, balloon sizing, and step-by-step planning for each lobe and lesion.

---

Get the BackTable app
https://www.backtable.com/app

---

Timestamps

00:00 - Introduction
02:48 - Procedural Setup and Vascular Access
06:31 - Sheath in Sheath Technique
11:20 - Guide Catheter Selection
17:53 - Wire Selection and Balloon Undersizing
22:12 - Crossing Chronic Total Occlusions
27:25 - Pulmonary Collaterals and Flush Occlusions
32:33 - Guide Extensions and Contrast Reduction
36:38 - Distal Perfusion Pressure Targets
41:26 - Pressure Wire Selection and Wire Management
45:54 - Balloon Sizing and Reperfusion Pulmonary Edema
54:04 - Hemoptysis and Gelatin Sponge Embolization
1:02:32 - Closing Remarks

---

More about this episode

Dr. Bashir describes a technique he has simplified over ten years, built around a single principle that the goal of the procedure is perfusion rather than a better looking angiogram. He explains why early sessions use deliberately undersized balloons to restore flow safely, how these lesions behave like scar tissue, and why retrograde approaches are risky in fragile pulmonary vessels. The discussion covers practical strategies for keeping distal pressure low, managing hemoptysis with balloon tamponade and gelatin sponge embolization, and staging treatment over several sessions. The discussion closes with advice on mechanical circulatory support planning and the judgment, preparation, and teamwork that make high-risk BPA safe and effective.

---

Resources

Mizoguchi H, Ogawa A, Munemasa M, Mikouchi H, Ito H, Matsubara H. Refined Balloon Pulmonary Angioplasty for Inoperable Patients With Chronic Thromboembolic Pulmonary Hypertension. Circ Cardiovasc Interv. 2012
https://doi.org/10.1161/CIRCINTERVENTIONS.112.971077

Auger WR, et al. Balloon Pulmonary Angioplasty for Treatment of Chronic Thromboembolic Pulmonary Hypertension: Statement From the BPA-CTEPH Alliance. JACC Cardiovasc Interv. 2026
https://doi.org/10.1016/j.jcin.2026.02.033

Nasri A, Bashir R, Lakhter V. Management of Complications of Balloon Pulmonary Angioplasty. Card Electrophysiol Clin. 2025
https://doi.org/10.1016/j.ccep.2024.12.015

Lang IM, et al. Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: Results of an International Multicenter Prospective Registry. J Am Coll Cardiol. 2025
https://doi.org/10.1016/j.jacc.2025.04.021

Aggarwal V, et al. Status and Future Directions for Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Disease With and Without Pulmonary Hypertension. A Scientific Statement From the American Heart Association. Circulation. 2024
https://doi.org/10.1161/CIR.0000000000001197

Inami T, et al. Pulmonary Edema Predictive Scoring Index (PEPSI), a New Index to Predict Risk of Reperfusion Pulmonary Edema and Improvement of Hemodynamics in Percutaneous Transluminal Pulmonary Angioplasty. JACC Cardiovasc Interv. 2013
https://doi.org/10.1016/j.jcin.2013.03.009

BackTable Cardiology Episode 36. Understanding CTEPH, Diagnostic and Interventional Techniques
https://www.backtable.com/shows/cardiology/podcasts/36/understanding-cteph-diagnostic-interventional-techniques

Dr. Riyaz Bashir, Mayo Clinic, Jacksonville
https://www.mayoclinic.org/biographies/bashir-riyaz-m-b-b-s-m-d/bio-20590757

Dr. Hady Lichaa, BackTable contributor page
https://backtable.com/shows/vi/contributors/dr-hady-lichaa

Dr. Hady Lichaa, Ascension Saint Thomas Heart
https://healthcare.ascension.org/doctors/1336267533/hady-t-lichaa-murfreesboro-tn

---

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 your questions in cardiology go beyond the bedside and into healthcare innovation and transformation, is an executive MBA your next step? On this episode of BackTable Cardiology, Dr. Ankit Patel interviews Dr. Abdulla A. Damluji of the Cleveland Clinic about his journey from clinical cardiology to business school, and how an MBA empowered him to drive real change in healthcare. Dr. Damluji shares how business education gave him the tools to lead new programs, challenge the financial assumptions behind emerging technologies, and build a cardiovascular center focused on aging.

---

Get the BackTable app
https://www.backtable.com/app

---

Timestamps

00:00 - Introduction
04:52 - Why Pursue an MBA
08:06 - Choosing the Right Program
11:15 - Building a Cardiovascular Center on Aging
14:54 - Balancing Clinical Work and Business School
18:48 - Focusing on Finance and Analytics
23:27 - Evaluating Programs and Medical Devices
29:47 - Reimbursement and Training Implications
33:05 - MBA Return on Investment and Opportunity Cost
36:28 - Who Should Consider an MBA
46:20 - Artificial Intelligence and Business Education
50:53 - The MBA’s Impact on Cardiology
54:33 - Closing Remarks

---

More about this episode

They discuss balancing clinical work with MBA coursework, using business frameworks to evaluate new programs and devices, and how finance and analytics shape impactful decisions. Dr. Damluji explains how the MBA network expands professional options, the importance of aligning business education with your mission in medicine, and why the degree is most powerful for physicians who want to solve problems that go beyond patient care at the bedside.

---

Resources

Dr. Ankit Patel’s Physician Profile
https://www.getcare.hackensackmeridianhealth.org/provider/ankitkumar-kirankumar-patel/1316247

Dr. Abdulla A. Damluji’s Physician Profile
https://providers.clevelandclinic.org/provider/abdulla-damluji/4826749

Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery (PARTNER trial)
https://www.nejm.org/doi/full/10.1056/NEJMoa1008232

Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients (PARTER 2 Trial)
https://www.nejm.org/doi/full/10.1056/NEJMoa1514616

NY Stern’s Executive Master in Business Administration (EMBA)
https://www.stern.nyu.edu/programs-admissions/executive-mba

---

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 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 app
https://www.backtable.com/app

---

This podcast is supported by

RADPAD® Radiation Protection
https://www.radpad.com/

---

Timestamps

00:00 - Introduction
04:00 - Three Key Indications for UHP Balloons
05:09 - Balloon Design, Material and Crossing Profile
07:32 - Intravascular Imaging and Case Planning
11:09 - Wire Compatibility and Buddy Wiring
13:55 - Calcium Morphology and Device Selection
17:43 - In-Stent Restenosis and Non-Dilatable Stents
20:33 - Sizing, Inflation Technique and Indeflators
28:21 - Post-Treatment Imaging and Calcium Fracture
31:16 - Perforation, Balloon Rupture and Dissection Risk
38:03 - Cost and Procedural Control
40:20 - Future Calcium Modification Technologies
41:37 - 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 app
https://www.backtable.com/app

---

This podcast is supported by

Endovascular Engineering (E2)
E2Helo.com

---

Timestamps

00:00 - Introduction
03:42 - Referral Patterns and PERT Scope
05:25 - PE Workup Essentials
07:26 - Targeted Assessment of Acuity
11:36 - Reliability of the Walk Test
14:35 - PE Treatment Pathways
19:26 - Procedural Walkthrough
24:15 - Catheter Sizing
30:05 - Adjunct Aspiration Device Features
35:09 - Blood Return Process and Safety
40:03 - Helo Study Early Results
45:09 - Determining Procedural Endpoints
50:20 - Future Trials and Technologies
53:48 - 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 Adults
https://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 study
https://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 app
https://www.backtable.com/app

---

This podcast is supported by
Teleflex
https://www.teleflex.com/

---

Timestamps

00:00 - Introduction
02:21 - Pre-PCI Case Planning
07:23 - Wires And Tracking Tricks
11:22 - Guide Extensions Masterclass
16:58 - Dampening And Safe Injection
20:19 - Calcified Lesion Escalation
26:55 - Stent Selection And ORSIRO
31:03 - Post-Procedure DAPT Strategy
37:38 - Perforation Rescue Playbook
44:28 - 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 Profile
https://nyulangone.org/doctors/1902066871/sripal-bangalore

Dr. Hady Lichaa’s Physician Profile
https://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa

The Elusive Late Benefit of Biodegradable Polymer Drug-Eluting Stents
https://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 app
https://www.backtable.com/app

---

This podcast is supported by
Imperative Care
https://www.imperativecare.com/

---

Timestamps
00:00 - Introduction
02:03 - PE Response Workflow
05:32 - Symphony Device
07:07 - Sizing and Blood Loss
10:00 - Multi-Port Hemodynamics
14:45 - Procedure Endpoints
17:01 - IVUS Guided Strategy
20:02 - ProHelix and Lollipopping
25:48 - Case Studies
34:12 - Closing Thoughts

---

More about this episode
The 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 Embolism
https://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-PE
https://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 app
https://www.backtable.com/app

---

This podcast is supported by
Penumbra
https://www.penumbrainc.com/

---

Timestamps
00:00 - Introduction
03:57 - PERT Structure and Activation
08:24 - PE Risk Stratification Tools
12:02 - Patient Selection for IR Intervention
15:21 - Assessing Clot Chronicity
21:03 - Standardizing Workup
26:38 - Managing Unstable PE
28:31 - STORM-PE and HI-PEITHO Trial Data
35:49 - Guidelines vs. New Evidence
40:12 - Determining Therapeutic Endpoints
45:05 - Upcoming Trials and Future Directions
51:46 - Final Thoughts and Closing Remarks

---

More about this episode
The 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 Adults
https://doi.org/10.1161/CIR.0000000000001415

Composite Pulmonary Embolism Shock (CPES) Score
https://doi.org/10.1161/CIRCINTERVENTIONS.124.014088

FOCUS study
https://doi.org/10.1093/eurheartj/ehac206

STORM-PE trial
https://doi.org/10.1161/CIRCULATIONAHA.125.077232

HI-PEITHO trial
https://doi.org/10.1056/nejmoa2516567

PE-TRACT study
https://petractstudy.org/homepage

PEERLESS II study
https://clinicaltrials.gov/study/NCT06055920

PERSEVERE trial
https://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 app
https://www.backtable.com/app

---

Timestamps

00:00 - Introduction
01:56 - Patient History
05:42 - CTA and Angio Findings
09:30 - Strategy Access and IVUS
13:17 - IVUS Sizing and Lesion Review
16:38 - IVL Angioplasty Technique
18:28 - Stenting and Final Result
22:50 - Post-procedure Meds and Outcome
24:34 - 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 app
https://www.backtable.com/app

---

Timestamps

00:00 - Introduction
02:35 - What Is Transcaval Access?
09:34 - Crossing Site Measurements
17:17 - Step-by-Step Procedure
20:26 - Electrosurgery Setup
28:04 - Troubleshooting Scenarios
34:36 - Lost Wire Recovery
39:19 - Balloon Tamponade Planning
44:00 - Step-by-Step Closure
53:31 - Hydration and Hemoglobin
01:00:42 - Training and Proctorship
01:04:42 - 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 Profile
https://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa

Dr. Pedro Villablanca Physician Profile
https://www.henryford.com/physician-directory/v/villablanca-spinetto-pedro

SCAI Structural Heart Disease Courses
https://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 app
https://www.backtable.com/app

---

Timestamps

00:00 - Introduction
02:51 - Private Practice Landscape
05:17 - Pendulum Swing to Independent Practice
10:04 - Making the Move to Solo Practice
15:24 - Training and Research Beyond Hospitals
17:55 - MBA and Business Skills
20:02 - Building a Broad Practice
23:35 - Income, Ownership, and Mindset Shifts
27:28 - Administrative Load and Management Help
32:35 - Launching the ASC Cath Lab
38:24 - Boosting Efficiency, Lifestyle, and Preventing Burnout
43:17 - Advice for Fellows
48:15 - Call Coverage and Negotiation
49:52 - 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 Institute
https://www.revascmed.com/

University of Cincinnati Ohio College of Medicine
https://med.uc.edu/

University Hospitals Case Medical Center
https://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 app
https://www.backtable.com/app

---

Timestamps
00:00 - Introduction
03:10 - Why ASCs Are Expanding
05:36 - Autonomy, Efficiency, and Key Concerns
10:43 - Ensuring Safety and Outcomes
14:07 - OEIS Registry and Certification
17:02 - Managing Complications and Transfers
22:36 - EP Procedures in the Outpatient Setting
27:09 - OBLs Under Pressure
34:43 - Reimbursement Challenges and Burnout
39:22 - Business Skills and Consultants
44:07 - Income Reality and Partnerships
50:12 - Reflection on the Transition
55:46 - Closing Thoughts and Advice

---

More about this episode
Dr. 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.

---

Resources
Interventional Cardiologists' Perspectives on Percutaneous Coronary Intervention at Ambulatory Surgical Centers
https://pubmed.ncbi.nlm.nih.gov/41088884/

OEIS
https://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 app
https://www.backtable.com/app

---

Timestamps

00:00 - Introduction
04:54 - Training And Early Career
07:38 - Mission Statement: TRECC
10:53 - The Impact of Mentorship
13:09 - Why Start NCH Meetings?
17:02 - Developing a Practice
21:35 - Workflow And Team Culture
26:33 - Training The Next Generation
32:16 - Venous Disease Gap
40:40 - Goals Mission Mindset
45:37 - Advice For Trainees
54:17 - 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 Profile
https://www.cardio.com/team/craig-walker’-md/

Dr. Ankit Patel’s Physician Profile
https://www.getcare.hackensackmeridianhealth.org/provider/ankitkumar-kirankumar-patel/1316247

New Cardiovascular Horizons
https://ncvh.org/

Temporary Occlusion Embolectomy: A Cost-Effective Approach to Distal Embolic Protection in Peripheral Artery Disease
https://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 app
https://www.backtable.com/app

---

This podcast is supported by

Sponsor
https://shockwavemedical.com/

---

Timestamps

00:00 - Introduction
04:48 - Hard CTO Case Insights
08:43 - CTO vs IVL Safety And Predictability
15:18 - Atherectomy Lesion Length for Atherectomy
23:13 - Interpreting Calcium on Imaging
27:58 - D-Shaped Stents after Calcium Modification
30:19 - Left Main Bifurcation Strategy
35:31 - IVL Versus Atherectomy Sequencing
39:49 - When To Stop A Case
50:28 - Future Of IVL And Imaging
53:47 - 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 app
https://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 - Introduction
04:00 - Bioengineering Origins
08:29 - 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 app
https://www.backtable.com/app

---

Timestamps

00:00 - Introduction
01:59 - Complex Case Walkthrough
09:47 - Preprocedure Workup
16:31 - Femoral Catheter Playbook
24:18 - Embolic Protection Strategy
26:12 - Step By Step Stenting Walkthrough
34:38 - Antiplatelet Checklist
48:18 - Tortuosity and Arch Tips
52:12 - Calcified Access Solutions
59:42 - 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 Protection
https://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 app
https://www.backtable.com/app

---

This podcast is supported by

Merit Medical
https://www.merit.com/product/solopace-fusion-system/

---

Timestamps

00:00 - Introduction
02:27 - Early LV Pacing Skepticism
06:08 - Backup Strategy and Capture Test
08:02 - Step by Step TAVR Workflow
12:32 - Reasons for Slow Adoption
14:04 - Wire Design and Iterations
15:55 - Sheath Support in Tough Anatomy
16:57 - Avoiding Aortic Scrape Risks
18:08 - Staffing and Table Roles
20:51 - Beyond TAVR Use
21:58 - Device Design and Reliability
24:16 - EZ-TAVI Data Breakdown
27:28 - Algorithms vs. RV Pacing
29:17 - Purpose Built LV Pacing Wrap Up
30:25 - 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 Trial
https://pubmed.ncbi.nlm.nih.gov/31857014/

SoloPACE
https://www.solopace.health/

Dr. Jeffrey Southard UC Davis
https://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 app
https://www.backtable.com/app

---

Timestamps

00:00 - Introduction
03:04 - Why CTA for CTO
05:24 - CTA Workflow and Photon Counting
07:15 - Key CTA Findings for Strategy
12:12 - In Lab CTA Overlay Case Example
15:20 - Planning for All Operators
17:07 - Guide Selection and Efficiency
18:23 - Reading CTA and Teamwork
22:46 - Photon Counting for Stents
24:01 - Limitations Kidney Rate BMI
31:13 - Building a CTA Program
33:26 - 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 Maran
https://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

How are advanced practice providers (APPs) helping to elevate cardiovascular care? In this episode of BackTable Cardiology, Dr. Sameh Sayfo, an interventional cardiologist at Baylor Scott & White in Dallas, interviews nurse practitioner Hallie McNew about her journey from bedside ICU nursing to leading roles in cardiac surgery and structural heart practice. They discuss the unique strengths APPs bring to cardiology teams, differences between NPs and PAs, and highlight how prior nursing experience, mentorship, and structured onboarding can elevate quality of care, efficiency, and communication for cardiac patients.

---

Get the BackTable app
https://www.backtable.com/app

---

Timestamps
00:00 - Introduction
06:54 - APP as a Communication Bridge
10:34 - Training New Cardiology APPs
15:12 - Day In Structural Surgery Role
17:55 - Learning Imaging And EKG Skills
21:44 - Conferences and Continuing Education
27:59 - Building APP Communities And Programs
33:52 - Outpatient Hybrid Models And Hiring
39:11 - Billing Value and Patient Trust
42:03 - Handling Difficult Patient Conversations
47:27 - Wrap Up and Credits

---

More about this episode
The conversation also covers best practices for orienting and mentoring new APPs, APP-led services, and the importance of learning to interpret primary data such as CT, ECHO, and EKG results. McNew shares insights on continuing education resources, including ACC subspecialty training, Mayo Clinic courses, and national meetings, plus strategies for building strong APP communities, optimizing staffing and billing models, and ways physicians and APPs can build patient trust. They also address the value of physician-APP partnerships, flexible scheduling, and the keys to creating true continuity from the hospital to the outpatient setting.

---

Resources

VIVA Conference
https://viva-foundation.org/

CRT Conference
https://crtmeeting.org/

TCT Conference
https://www.tctconference.com/

Dr. Sameh Sayfo
https://www.bswhealth.com/physician/sameh-sayfo

---

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