Coronary drug-eluting balloon technology continues to evolve, but has its utilization been stunted by stenting? In this episode, Dr. Sameh Sayfo, an interventional cardiologist, hosts Dr. Ron Waksman, an internationally recognized cardiologist and scientist, to discuss advancements in coronary interventions and the age-old question of which coronary revascularization tools to use in which clinical scenarios.---SYNPOSISDr. Waksman shares his 30-year journey in the field, detailing the history and transition from traditional balloon angioplasty to drug-eluting stents, and now to drug-coated balloons. They explore the benefits and challenges of each technology, the significance of vessel preparation, and the latest trials, including the De Novo Trial led by Dr. Waksman. The conversation also touches on the importance of physician education and proper training in adopting new technologies. Additionally, Dr. Waksman provides insights into his approach to conducting interviews with notable public figures and hints at future discussions at the CRT annual meeting, potentially featuring President Biden.---TIMESTAMPS00:00 - Introduction03:40 - The History of Drug-Eluting Stents07:25 - Vessel Preparation To Ensure Good Balloon Angioplastic Technique10:36 - Bioabsorbable Scaffolds 14:57 - The AGENT IDE Randomized Clinical Trial20:16 - The Use of Paclitaxel Versus Sirolumus in Drug-Eluting Stents29:40 - Cardiovascular Research Technologies (CRT) Annual Meeting31:02 - Advice for Early Stage Colleagues---RESOURCESDr. Sameh Sayfo:https://www.bswhealth.com/physician/sameh-sayfoDr. Ron Waksmanhttps://www.medstarhealth.org/doctors/ron-waksman-mdDe Novo Trial, Drug-Coated Balloon for De Novo Coronary Artery Disease: Journal of American College of Cardiology State-of-the-Art Reviewhttps://pubmed.ncbi.nlm.nih.gov/32138967/The AGENT IDE Randomized Clinical Trial, Paclitaxel-Coated Balloon vs Uncoated Balloon for Coronary In-Stent Restenosis: The AGENT IDE Randomized Clinical Trialhttps://pubmed.ncbi.nlm.nih.gov/38460161/

PERT Consortium 2025 gives interventionalists the reins to tackle even the toughest saddle pulmonary embolisms. In this episode of the BackTable Podcast, host Dr. Aaron Fritts welcomes interventional radiologist Dr. Osman Ahmed and interventional cardiologist Dr. Jonathan Paul to discuss their experiences at the annual PERT Consortium in San Diego, and offer their perspectives on the latest developments in pulmonary embolism (PE) treatment. --- SYNPOSIS The doctors delve into advancements and trials within the PE treatment space, including new devices and clinical studies that are set to shape the future of pulmonary embolism care. The conversation highlights the value of collaboration between interventional specialties, the safety and efficacy of various PE interventions, and the growing trend of using combined therapies. They also provide updates on their ongoing innovation with Flow Medical, describing their philosophy and motivation for developing a new device for PE treatment that incorporates real-time pulmonary artery pressures, mean systolic and diastolic pressures, and a potential for AI utilization in the future. --- TIMESTAMPS 00:00 - Introduction01:23 - PERT Consortium Highlights02:11 - Emerging Clinical Trials and Innovations03:59 - Thrombectomy Devices and Market Trends12:37 - Flow Medical: Origin and Updates19:37 - Advanced Data Tracking in Cardiology20:45 - Remote Monitoring and Mobile Integration22:45 - Cardiologists’ Data-Driven Approach23:10 - Upcoming Studies and Data Insights24:10 - Interventional Radiology and Cardiology Collaboration25:07 - Access to Care and Procedure Adoption27:32 - Final Thoughts --- RESOURCES Pulmonary Embolism Response Team (PERT) Consortiumhttps://pertconsortium.org/ Flow Medicalhttps://www.flowmedical.co/ PEERLESS RCThttps://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.072364 RESCUE-IIhttps://www.jacc.org/doi/10.1016/j.jacadv.2025.101789 PEERLESS II https://www.jscai.org/article/S2772-9303(24)01053-6/fulltext Pulmonary Embolism - Thrombus Removal With Catheter-Directed Therapy (PE-TRACT)https://clinicaltrials.gov/study/NCT05591118 The HI-PEITHO Studyhttps://www.bostonscientific.com/en-EU/medical-specialties/vascular-surgery/venous-thromboembolism-portal/pulmonary-embolism/clinical-data/hi-peitho.html PRAGUE-26https://eurointervention.pcronline.com/article/design-and-rationale-of-prague-26-a-multicentre-randomised-trial-of-catheter-directed-thrombolysis-for-intermediate-high-risk-acute-pulmonary-embolism Pulmonary Embolism - Thrombus Removal With Catheter-Directed Therapy (PE-TRACT) https://clinicaltrials.gov/study/NCT05591118 Aaron Fritts, MDhttps://www.backtable.com/shows/vi/contributors/dr-aaron-fritts Osman Ahmed, MDhttps://jointvascular.com/team/osman-ahmed-m-d-fcirse/ Jonathan Paul, MDhttps://www.uchicagomedicine.org/find-a-physician/physician/jonathan-d-paul

Real intracardiac echo cases, real-time developments! In this episode of BackTable Cardiology, host Dr. Sam Sayfo is joined by Dr. Karim Al-Azizi, a structural interventional cardiologist at Baylor Scott & White Heart Hospital Plano. Together, they explore the evolving role of intracardiac echocardiography (ICE) through three real cases of ICE use in structural heart interventions. Join as they walk through patient profiles, imaging strategies, and clinical outcomes from ICE-guided cases.---SYNPOSISDr. Al-Azizi shares his journey into the field of structural heart disease, highlighting the practical benefits and challenges of ICE and describing how it is transforming procedural guidance and patient outcomes. The episode concludes with a discussion on the Dallas PCI conference, emphasizing practical, hands-on learning for physicians.---TIMESTAMPS00:00 Introduction to AI in Cardiology00:52 Meet the Hosts and Guest01:30 Dr. Azizi's Journey into Structural Heart Disease02:46 Advancements in Structural Heart Procedures05:38 Intracardiac Echocardiography (ICE) Explained09:27 Practical Applications of ICE13:53 Learning and Training in ICE17:22 Comparing ICE Technologies22:38 Case Studies: ICE in Action43:54 Dallas PCI Conference and Closing Remarks---RESOURCESDr. Karim Al-Azizihttps://www.bswhealth.com/physician/karim-al-aziziDr. Sameh Sayfohttps://www.bswhealth.com/physician/sameh-sayfoBaylor Scott & White Heart Hospital Planohttps://www.bswhealth.com/the-heart-hospital/locations/planoICE Overviewhttps://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.031343ICE Use in SVT and Afibhttps://pmc.ncbi.nlm.nih.gov/articles/PMC11270097/ICE Use in Left Atrial Appendagehttps://pmc.ncbi.nlm.nih.gov/articles/PMC12209866/

What coronary device do you reach for when a blockage won’t budge? In this episode of the BackTable Cardiology Podcast, Dr. Wissam Jaber from Emory University Hospital joins host Dr. Hady Lichaa to discuss the intricacies of coronary atherectomy, outlining the differences between rotational and orbital atherectomy, their indications, and their technical nuances.---SYNPOSISDr. Jaber shares his experiences with both rotational and orbital atherectomy, when he uses which for specific lesion subsets, potential complications, and strategies to manage them. This episode provides essential insights for cardiologists seeking to enhance their proficiency in managing calcified coronary lesions.---TIMESTAMPS00:00 - Introduction04:39 - Use of Lasers in Atherectomy07:12 - Determining Guide and Catheter Size14:24 - Laser Contrast Mix17:15 - Perforation Detection and Management25:16 - Treating the Circumflex Ostium 32:17 - Using a Guide Extension Catheter with Atherectomy Devices36:36 - Orbital Versus Rotational Atherectomy47:21 - Navigating Tortuosity in Atherectomies52:45 - Complications (Perforations, Dissections and Distal Embolizations)---RESOURCESDr. Wissam Jaberhttps://providers.emoryhealthcare.org/provider/wissam-a-jaber/777074Dr. Hady Lichaahttps://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa

Ballin’ on a contrast budget! In this episode of BackTable Cardiology, Dr. Evan Shlofmitz outlines how utilizing imaging and physiology get you the most bang for your buck when performing low contrast PCI for patients with renal impairment.---SYNPOSISDr. Shlofmitz, co-director of Optimize PCI (OPCI) and a leading expert in intravascular imaging and physiology from St. Francis Hospital, New York, joins Dr. Sameh Sayfo, interventional cardiologist from Baylor Scott & White The Heart Hospital. Together, they delve into the importance of low contrast PCI, strategies to prevent contrast-induced nephropathy, and the use of advanced imaging techniques to aid in low contrast procedures that are critical for patients with renal impairment. Dr. Shlofmitz shares insights into staging interventions, optimal use of contrast, and the integration of technologies like dynamic coronary roadmap and angiography-derived physiology. They also discuss the vital role of multidisciplinary collaboration, physician education, and industry support in enhancing patient outcomes by advocating for technology advancements in the cath lab. Dr. Shlofmitz highlights the Optimize PCI (OPCI) conference, which continues to advance the interventional cardiology field by providing hands-on workshops and regional courses in percutaneous cardiac procedures, imaging, access techniques, and much more.---TIMESTAMPS00:00 - Introduction to Guests 02:11 - Impaired Renal Function and Contrast Induced Nephropathy 06:55 - Contrast, GFR, and Hydration Status: Cath Lab Strategies for CKD12:24 - NCDR and Quality Metrics for CIN15:28 - Multidisciplinary Care: Bringing Nephrology on Board 18:26 - Staging Diagnostic and Intervention Procedures to Reduce Contrast20:39 - Ultra Low Contrast Diagnostic Angiogram Technique25:28 - Moderate Lesions in Ultra Low Contrast 29:36 - Technology: iFR Co-registration and Diagnostic Coronary Roadmap40:15 - Physician Champions: Advocates for Implementing New Imaging46:33 - Optimizing PCI (OPCI) Conference 50:40 - Conclusion---RESOURCESEvan Shlofmitz Provider Profilehttps://doctors.catholichealthli.org/provider/evan-scott-shlofmitz/2405486Intravascular Lithotripsy for Treatment of Severely Calcified Coronary Lesions: 1-Year Results From the Disrupt CAD III Studyhttps://www.jscai.org/article/S2772-9303(21)00001-6/fulltextSameh Sayfo Provider Profilehttps://www.bswhealth.com/physician/sameh-sayfoStatewide Initiative to Increase Intracoronary Imaging Optimization in PCI: A Report From the BMC2 Registryhttps://www.jscai.org/article/S2772-9303(25)01152-4/fulltextOptimize PCI (OPCI) - November Hands-On Workshiphttps://opci.live/event/opci-michigan-2025/Optimize PCI (OPCI) https://opci.live/

Reporting from inside the cath lab: advanced PCI techniques, cutting-edge imaging, and the future of interventional cardiology! In this episode of the BackTable Cardiology Podcast, Dr. Sam Sayfo hosts Dr. Mirvat Alasnag, the director of research at the Cardiac Catheterization Lab at King Fahd Armed Forces Hospital in Saudi Arabia to discuss various coronary bifurcation intervention strategies, including TAP, DK Crush, and their indications.---SYNPOSISThe conversation delves into the use of drug-coated balloons (DCB), intracoronary imaging techniques like IVUS and OCT, and the importance of personalized patient care in high-risk percutaneous coronary interventions (PCIs). Additionally, Dr. Alasnag addresses the challenges and innovations in supporting women in interventional cardiology and the value of mentorship and career shadowing programs for aspiring cardiologists.---TIMESTAMPS00:00 - Introduction02:06 - Understanding Bifurcation Coronary Intervention04:00 - Strategies for Bifurcation Stenting09:55 - The Role of Drug-Coated Balloons13:08 - Importance of Intra-Coronary Imaging16:31 - Global Perspectives on Bifurcation Interventions27:57 - Advocacy for Women in Interventional Cardiology31:42 - Mentorship and Career Guidance---RESOURCESDr. Mirvat Alasnag:https://www.radcliffecardiology.com/authors/mirvat-alasnag?language_content_entity=enhttps://esc365.escardio.org/person/367232Dr. Sameh Sayfo:https://www.bswhealth.com/physician/sameh-sayfoKing Fahad Armed Forces Hospital:https://www.linkedin.com/company/king-fahad-armed-forces-hospital/?trk=public_profile_topcard_past_company&originalSubdomain=ieNew Innovations at King Fahad Armed Forces Hospital (Jeddah)https://elixirmedical.com/king-fahad-armed-forces-hospital-begins-trial-of-new-bioadaptive-angioplasty-procedure-for-heart-disease-treatment/Fundamentals of percutaneous coronary bifurcation interventions:https://pmc.ncbi.nlm.nih.gov/articles/PMC8968454/Bifurcation stenting: current strategies and new deviceshttps://heart.bmj.com/content/95/6/495.short

It’s no shock that percutaneous ventricular assist devices (pVADs) play an important role in improving cardiogenic shock outcomes (pun intended). In this episode of the BackTable Cardiology Podcast, host Dr. Sameh Sayfo interviews Dr. Babar Basir, a renowned interventional cardiologist from Michigan, about advancements and protocols in managing cardiogenic shock. --- SYNPOSIS Dr. Babar Basir details the history and development of the cardiogenic shock program initiated at Henry Ford Hospital, its national expansion, and its impact on patient outcomes. The conversation touches on the role of advanced heart failure specialists, ongoing trials like the Door to Unload trial, and the importance of small bore mechanical circulatory support devices. Dr. Babar Basir also highlights the significance of team-based approaches and the necessity of multidisciplinary care in improving survival rates for patients suffering from cardiogenic shock. --- TIMESTAMPS 00:00 - Introduction03:50 - Impella in Shock: From Last-Resort to Early Use 07:30 - National Cardiogenic Shock Initiative 14:30 - Heart Failure Readmissions 17:46 - Additional Indications for Use of Impella Device 24:10 - Future Devices and Technological Advancements in the Field27:03 - International Advancements in Shock Initiative Protocols30:28 - Using Impella CP vs Impella 5.5 38:20 - SCAI Shock Conference and Importance of Attending --- RESOURCES Dr. Sameh Sayfo:https://www.bswhealth.com/physician/sameh-sayfo Dr. Babar Basir:https://www.henryford.com/physician-directory/b/basir-mir National Cardiogenic Shock Initiativehttps://www.henryford.com/cardiogenicshock Unloading the Left Ventricle Before Reperfusion in Patients With Anterior ST-Segment-Elevation Myocardial Infarction (also known as “Door to Unload Trial”):https://pubmed.ncbi.nlm.nih.gov/30586728/ Upcoming SCAI Shock Conference September 18th-20th, 2025https://scai.org/education-and-events/events-schedule/2025-scai-shock-0

Calcium belongs in the bones, not the blood vessels! But once it’s there, how can interventional cardiologists use their skills and tools to combat it? In this episode of the BackTable Cardiology Podcast, host Dr. Hady Lichaa interviews Dr. Yader Sandoval from the Minneapolis Heart Institute about handling coronary calcification. --- SYNPOSIS Dr. Sandoval shares insights into the challenges of treating calcified coronary lesions, the importance of intravascular imaging, and his strategic approach to using technologies like intravascular lithotripsy, atherectomy, and specialty balloons. He emphasizes practical tips and tricks for interventional cardiologists to optimize procedure outcomes and tackle severe coronary calcification effectively. Their discussion overviews the latest innovations in the field, providing valuable advice for balancing advanced techniques with procedural efficiency. Dr. Sandoval also details the where, when, and how of approaching in-stent restenosis (ISR), including how to use imaging to optimize treating heavy calcifications around stents. --- TIMESTAMPS 00:00 - Introduction01:57 - Overview of Coronary Calcification08:08 - Severe Calcification Cases: Equipment and Technique21:08 - Guide Wires, Microcatheters, and Guide Extensions for Calcified Lesions31:24 - IVUS vs OCT36:21 - Atherectomy vs IVL Considerations43:32 - Calcified Nodules 51:06 - Stents and In-Stent Restenosis Management56:42 - Conclusion --- RESOURCES Dr. Yader Sandovalhttps://mplsheart.org/yader-sandoval-md Abbott Northwestern Hospital Dr. Hady Lichaahttps://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa SCAI Expert Consensus Statement on Management of In-Stent Restenosis and Stent Thrombosishttps://pmc.ncbi.nlm.nih.gov/articles/PMC11308135/

The toolbox for vessel preparation is rapidly expanding. Are you keeping up? In this episode, host Dr. Sabeen Dhand is joined by Dr. Jay Mathews, interventional cardiologist (Manatee Memorial Hospital) and Dr. Michael Siah, vascular surgeon (UT Southwestern), to explore the latest innovations and strategies in vessel prep. --- This podcast is supported by: Cagent Vascularhttps://cagentvascular.com/ --- SYNPOSIS The discussion opens with a look at new additions to their practice over the past few years, including bioresorbable scaffolds for below-the-knee interventions and retrievable stent technologies. Both experts emphasize the role of imaging—particularly CT angiography and IVUS—and discuss how renal disease impacts their use of contrast during diagnosis and intervention. They then walk through how they assess vessels on angiography or IVUS to decide when and where to use specialty tools. From intravascular lithotripsy for managing dense calcification to serration angioplasty, the conversation highlights how the doctors decide to use specialty balloons and devices. The episode also touches on the practical challenges of balancing device cost with treatment effectiveness. The physicians break down the latest specialty balloons and devices and touch on their own experiences with them. To close, the guests share what emerging technologies they’re most excited about and how these devices could change their day-to-day practice. Whether you’re in IR, cardiology, or vascular surgery, this episode offers a valuable roadmap to the current and future state of vessel preparation. --- TIMESTAMPS 00:00 - Introduction04:07 - New Changes in Techniques14:57 - Vessel Characteristics on Angiogram18:10 - Approaches to Above-the-Knee vs. Below-the-Knee Disease23:48 - Latest Specialty Balloons46:14 - New Devices on the Horizon50:58 - Words of Advice and Final Thoughts --- RESOURCES POINT FORCE Registry: ​https://evtoday.com/news/cagent-initiates-point-force-registry-of-serranator-pta-catheter?c4src=news

How do you navigate tortuous coronary vasculature? In this episode of BackTable Cardiology, Dr. Hady Lichaa hosts Dr. Alexander Truesdell, an interventional cardiologist with extensive experience in overcoming complex cases of vessel tortuosity. --- SYNPOSIS Beginning with Dr. Truesdell’s background and expertise, the discussion delves into best practices for evaluating and navigating tortuous anatomy both diagnostically and interventionally, the use of various wires, guides, and support techniques, and how to effectively use imaging and atherectomy tools. They also touch on practical aspects of tackling coronary tortuosity, like procedural preparation, equipment choices, and the importance of continuous learning in an evolving area of medicine. --- TIMESTAMPS 00:00 - Introduction02:07 - Approaching Cases of Extreme Tortuosity14:04 - Defining Tortuosity of the Coronary Vessels18:40 - Guide Size and Equipment Strategy in Complex PCI 35:04 - Distal Guide Extension Catheter Use and One Potential Risk 43:16 - Using Imaging Catheters 49:25 - Discussion of Avoiding Complications57:40 - Selecting Stents 01:04:00 - Guide Extension Use Through Pseudo Lesions to Decrease Ischemic Time01:11:00 - Parting Advice for New and Mid-Career Interventional Cardiologists --- RESOURCES Dr. Alexander Truesdell’s Provider Profile:https://www.virginiaheart.com/find-a-provider/physicians/alexander-g-truesdell Dr. Hady Lichaa’s Provider Profile:https://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa Transradial Peripheral Vascular Intervention: Challenges and Opportunities:https://www.openaccessjournals.com/articles/transradial-peripheral-vascular-intervention-challenges-and-opportunities.html

In 2024, the DanGer Shock trial changed cardiogenic shock guidelines and affected practice patterns internationally. This episode of the BackTable Cardiology Podcast explores tips, tricks, and best practices in utilizing Impella, ECMO, and national initiatives to most effectively treat patients with cardiogenic shock. Host Dr. Sameh Sayfo interviews Dr. Amir Kaki, a noted interventional cardiologist and Director of Mechanical Circulatory Support and Complex PCI at Henry Ford St. John Hospital in Detroit. --- SYNPOSIS The discussion centers on the advances in mechanical circulatory support devices like Impella and ECMO, their history, usage criteria, and impact on patient outcomes. Dr. Kaki details the landmark Detroit Cardiogenic Shock Initiative, the challenges surrounding ECMO use, and the critical implementation of the recent DanGer-SHOCK Trial in clinical practice. After outlining the history of interventions for cardiogenic shock and the significance of recent trials within the field, he emphasizes the necessity for contemporary cardiologists to be skilled in endovascular techniques. --- TIMESTAMPS 00:00 - Introduction02:12 - National Cardiogenic Shock Initiative06:23 - Shock 2 Trial07:48 - ECLS-SHOCK Trial and ECMO15:05 - DanGer Trial22:56 - Parameters for Impella RP vs Impella CP Use in Cardiogenic Shock29:39 - Impella Considerations: Placement, Limb Ischemia, Removal 37:56 - Modern Cardiogenic Shock: Overview and Resources40:16 - Conclusion --- RESOURCES The National Cardiogenic Shock Initiative:https://www.ahajournals.org/doi/10.1161/JAHA.123.031401 DanGer Shock Trial:https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2024/04/05/04/44/danger-shock Large-Bore Access Site Managementhttps://assets.bmctoday.net/citoday/pdfs/cit0719_SF2_Kaki.pdf Short-Term Mechanical Circulatory Support for Cardiogenic Shockhttps://scai.org/publications/ebooks/short-term-mechanical-circulatory-support-cardiogenic-shock Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shockhttps://www.nejm.org/doi/full/10.1056/NEJMoa1208410 Extracorporeal Life Support in Infarct-Related Cardiogenic Shockhttps://www.nejm.org/doi/full/10.1056/NEJMoa2307227 Dr. Amir Kaki, MDhttps://www.heartteam.com/provider/amir-kaki-mdhttps://scai.org/about-us/scai-staff-listing/amir-kaki-md-fscai Dr. Sameh Sayfohttps://www.bswhealth.com/physician/sameh-sayfo

What are the biggest challenges in large bore access and closure? In our inaugural episode of the BackTable Cardiology Podcast, Dr. Hady Lichaa hosts Dr. Jason Wollmuth, an interventional cardiologist renowned for his expertise in large bore access techniques. --- SYNPOSIS Dr. Wollmuth shares his journey in interventional cardiology, detailing his early experiences managing complex PCI cases and CTOs. They delve into the specifics of large bore access, including preparation and imaging, access techniques, managing complications, and the use of single access for complex cases. The discussion also covers equipment preferences, handling vascular disease, mitigating limb ischemia, and alternative access strategies such as axillary and carotid approaches. Dr. Wollmuth highlights the importance of procedural practice, interdisciplinary collaboration, and continued learning from experienced colleagues. --- TIMESTAMPS 00:00 - Introduction01:46 - Large-bore Access Adoption 08:00 - Micropuncture Technique for Initial Access11:30 - Challenges of Getting Antegrade Access17:20 - Practicing Emergent Scenarios in Non Emergent Settings 22:09 - Managing Calcified or Tortuous Arteries44:00 - Limb Ischemia Mitigation54:46 - The Sideclose Technique01:01:00 - Single Access Closure Method01:09:00 - Using Axillary Access Instead of Femoral --- RESOURCES Dr. Jason Wollmuth’s Provider Profile:https://www.providence.org/doctors/interventional-cardiology/or/portland/jason-wollmuth-1164498499 Dr. Hady Lichaa’s Provider Profile:https://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa The Sideclose Technique: A Novel Method for Achieving Hemostasis With an Indwelling Impella CP:https://www.jscai.org/article/S2772-9303(24)01363-2/pdf