Backtable Cardiology – Details, episodes & analysis

John Doe is a 45 year-old male with a past medical history of hypertension, on high doses of amlodipine, metoprolol and lisinopril presenting to his cardiologist with a blood pressure of 165/86. He asks, “If the medications are not controlling my blood pressure, what are my options?” In this episode of the BackTable Cardiology Podcast, Dr. Sameh Sayfo sits down with Dr. Eric Secemsky, an internationally recognized interventional cardiologist and vascular medicine specialist to discuss renal denervation, a minimally invasive procedure that lowers blood pressure by disrupting overactive renal sympathetic nerves. --- SYNPOSIS From its proof of concept to the clinical trials that have shaped the current landscape, Drs. Sayfo and Secemsky dive into the intricacies of renal denervation. They explore the technical aspects of catheter-based denervation devices like Medtronic's Spyral catheter and Recor's Paradise device, discussing their procedures, safety features, and troubleshooting tips. The conversation also covers the significance of building advanced hypertension centers, the latest in renal denervation innovations, and the creation of a national registry to track procedural outcomes and enhance patient care. --- TIMESTAMPS 00:00 - Introduction02:52 - Guidelines Update: Why Renal Denervation Earned a Class 2B Recommendation07:31 - Clinical Trials: What Went Wrong, What We Learned, and How Devices Improved15:08 - Medtronic Symplicity Spyral22:17 - ReCor Paradise27:30 - Covering the Main Renal Artery: Anatomic Variants and Proximal Treatment Strategy33:15 - Beyond Kidneys: Multi-Organ Denervation and Metabolic Effects40:27 - Why Institutions Should Build Hypertension Centers --- RESOURCES Dr. Sameh Sayfo’s Provider Profilehttps://www.bswhealth.com/physician/sameh-sayf Dr. Eric Secemsky’s Provider Profilehttps://findadoc.bidmc.org/details/3519 A Controlled Trial of Renal Denervation for Resistant Hypertensionhttps://www.nejm.org/doi/full/10.1056/NEJMoa1402670 Medtronic Symplicity Spyral™ Renal Denervation Systemhttps://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/symplicity-spyral-renal-denervation-system.html SPYRAL GEMINI Pilot Studyhttps://clinicaltrials.gov/study/NCT06907147 Ablation of Arteries for the Treatment of Type 2 Diabetes Mellitus and Its Comorbidities (NECTAR IV) Trial https://clinicaltrials.gov/study/NCT05369065

How do imaging, intravascular lithotripsy, and equipment selection come together to effectively target coronary calcium? In this episode of BackTable, interventional cardiologists Dr. Robert Riley (Overlake Medical Center in Bellevue, Washington) and Dr. Yousif Ahmad (UCSF) trade techniques and discuss various aspects of calcium modification in complex percutaneous coronary intervention (PCI). --- This podcast is supported by: Shockwave Medicalhttps://shockwavemedical.com/ --- SYNPOSIS The discussion begins with an overview of intravascular lithotripsy (IVL), including its mechanism of action, ideal lesion characteristics, and performance across varying calcium morphologies. The conversation then expands to comparative decision-making among atherectomy, specialty balloons, and IVL, emphasizing how intravascular imaging informs procedural planning and real-time optimization. Key clinical data are reviewed, including the Disrupt CAD I-IV series as well as findings from the Short-Cut and VICTORY trials. The episode concludes with a forward-looking discussion on emerging technologies and the ongoing challenge of treating calcified nodules, one of the most demanding substrates in coronary intervention. --- TIMESTAMPS 00:00 - Introduction04:16 - Complex PCI and Calcium Modification Tools04:43 - Intravascular Lithotripsy (IVL) Insights and Evolution12:08 - Calcium Modification Algorithms and Techniques27:24 - IVUS vs. OCT Imaging and Specialty Balloons32:12 - Challenges in Implementing New Techniques37:09 - Influential Studies in Calcium Modification40:52 - Recent Studies: Short-Cut and VICTORY53:11 - Future of Calcium Modification Technologies57:48 - Final Thoughts --- RESOURCES Dr. Robert Rileyhttps://www.scai.org/robert-f-riley-md-ms-fscai Dr. Yousif Ahmadhttps://profiles.ucsf.edu/yousif.ahmad Intravascular imaging-guided coronary drug-eluting stent implantation: an updated network meta-analysishttps://pubmed.ncbi.nlm.nih.gov/38401549/ Coronary intravascular lithotripsy for severe coronary artery calcification: The Disrupt CAD I-IV trialshttps://www.sciencedirect.com/science/article/abs/pii/S1553838924000769 Orbital Atherectomy vs. Conventional Balloon Angioplasty in Severely Calcified Coronary Arteries Prior to DES Implantation - ECLIPSEhttps://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 - A Randomized Controlled Trial (Short-Cut)https://clinicaltrials.gov/study/NCT06089135 The Value of IVL Compared To OPN Non-Compliant Balloons for Treatment of RefractorY Coronary Lesions (VICTORY) Trial (VICTORY)https://clinicaltrials.gov/study/NCT05346068

Transcatheter aortic valve replacement (TAVR) may be a standard cardiac procedure today, but its origin story follows an intriguing tale of courage, innovation and heart. In this episode of BackTable Cardiology, renowned cardiothoracic surgeon Dr. Michael Mack, a global leader in structural heart disease from Baylor Scott White Health, shares the history of TAVR, highlighting its origins, key clinical trials, and the eventual success of TAVR as a primary therapy. --- SYNPOSIS Dr. Michael Mack and host Dr. Sameh Sayfo discuss the early adaptations, challenges, and adoption of TAVR, detailing the collaborative efforts amongst medical professionals that led to its widespread utilization. They also explore the future of valve technology and the importance of multidisciplinary teamwork in advancing cardiovascular care. The discussion concludes with insights into emerging heart technologies and the evolving partnership between different medical specialties. --- TIMESTAMPS 00:00 - Introduction02:27 - Inception of TAVR03:01 - The Global Reach of TAVR11:10 - Placement of Aortic Transcatheter Valves (PARTNER) Trial 19:10 - Advancements in Cardiac Imaging20:35 - Mapping the Next Five Years23:20 - Strides in Aortic Insufficiency 25:16 - Collegiality in Cardiac Care --- RESOURCES How Transcatheter Aortic Valve Implantation (TAVI) Was Born: The Struggle for a New Inventionhttps://pmc.ncbi.nlm.nih.gov/articles/PMC8511628/ Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgeryhttps://www.nejm.org/doi/full/10.1056/NEJMoa1008232 Transcatheter Aortic-Valve Replacement in Low-Risk Patients at Five Yearshttp://nejm.org/doi/full/10.1056/NEJMoa2307447 Dr. Michael Mack Provider Profileshttps://news.bswhealth.com/en-US/photos/michael-mack-md Dr. Sameh Sayfo Provider Profilehttps://www.bswhealth.com/physician/sameh-sayfo

When there's something strange in your vasculature, who are you going to call? Clot busters! In this episode of the BackTable Podcast, interventional cardiologist Dr. Sameh Sayfo hosts interventional radiologist Dr. Sabah Butty from Indiana University to discuss contemporary interventional approaches to pulmonary embolism (PE). --- This podcast is supported by: Angiodynamicshttps://www.angiodynamics.com/ --- SYNPOSIS Dr. Butty shares his extensive experience in managing venous thromboembolism (VTE) and pulmonary embolism, highlighting the evolution of treatment strategies over the past 15 years. The discussion covers the shift from catheter-directed thrombolysis (CDT) to large bore mechanical thrombectomy, the importance of understanding the disease process, the efficiency and effectiveness of various devices–including the Alpha Vac–and the importance of achieving both short-term and long-term efficacy. Dr. Butty also shares insights on post-procedure management and follow-up protocols for PE patients. --- TIMESTAMPS 00:00 - Introduction02:53 - Development of AMI, Stroke and VTE Management07:52 - Device Selection04:25 - The Shift in Mechanical and Medicinal Therapies 13:23 - The Alpha Vac Device16:50 - Benefits of Using Alpha Vac Device20:26 - Considerations for Blood Loss During Procedure 24:30 - End of Case Criteria for Thrombectomy28:24 - Post Procedure Follow-Up --- RESOURCES Dr. Sameh Sayfo Provider Profilehttps://www.bswhealth.com/physician/sameh-sayfo Dr. Sabah Butty Provider Profile https://iuhealth.org/find-providers/provider/sabah-d-butty-md-5216 Prospective Multicenter IDE Study of the Next-Generation Precision Aspiration Thrombectomy System for Intermediate-Risk Pulmonary Embolism: The SYMPHONY-PE Trialhttps://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.125.015815

Sham-controlled, randomized, and double-blind: the COSIRA II trial has the makings to make big waves in the management of refractory angina. This week’s episode features two interventionalists that are well-versed in coronary sinus reducers and the trials investigating them. Dr. Ziad Ali, from St. Francis Hospital and Heart Center in New York, and Dr. Jai Khatri, with Weill Cornell Medicine, join BackTable Cardiology to discuss the challenges and potential solutions in treating refractory angina in interventional cardiology. --- This podcast is supported by: Shockwave Reducerhttps://shockwavemedical.com/clinical-evidence/cosira-ii/ --- SYNPOSIS The doctors cover the current approaches to managing chronic angina before and after PCI, discuss how to differentiate ischemic heart disease from non-ischemic chest pain, and address the burdens faced by patients with complex atherosclerotic disease. A significant focus of the episode is on the role of the coronary sinus reducer, including procedure technique, risks, benefits, and its potential for treating both obstructive coronary artery disease and microvascular disease. The doctors also explore the logistics and challenges of enrolling patients in the COSIRA-II trial and speculate on the future impact of this device in clinical practice. --- TIMESTAMPS 00:00 - Introduction01:42 - Understanding Refractory Angina03:36 - Diagnostic Approaches06:32 - Medical Therapy for Angina10:29 - Complex Cases and Treatment Strategies18:00 - Coronary Sinus Reducer27:11 - Understanding the Risks and Learning Curve28:06 - The COSIRA II Trial30:27 - Tips for Patient Recruitment and Management33:05 - Handling Treadmill Tests and Patient Communication38:10 - Referral Patterns and Inter-Institutional Collaborations45:38 - Future of Coronary Sinus Reducer50:33 - Final Thoughts --- RESOURCES Dr. Ziad Alihttps://ziadalimd.com/ Dr. Jai Khatrihttps://doctors.nyp.org/jaikirshan-khatri-md/cardiology-weill-greenberg-center COSIRA Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1402556 COSIRA II Trial https://clinicaltrials.gov/study/NCT05102019

Tricuspid valve repair has seen booming growth in the interventional arena in the last five years, and the trajectory is only up from here. In this episode, interventional cardiologists Dr. Joe Walsh and Dr. Aiden Raney share their wealth of insights and experiences with the latest advancements in tricuspid interventions. --- SYNPOSIS The conversation covers recent landmark trials, relevant tricuspid physiology, and hands-on experiences in the cath lab with specialty devices like TriClip and Evoque. The interventionalists discuss patient selection, including how to distinguish which patients are most likely to benefit from intervention and how to define procedural success. Dr. Walsh and Dr. Raney also highlight the educational opportunities provided by MurmurMD, a specialized social media platform for peer-to-peer learning for cardiologists and cardiac surgeons. --- TIMESTAMPS 00:00 - Introduction01:29 - Tricuspid Valve Interventions: An Overview03:55 - Understanding Tricuspid Regurgitation10:29 - Therapeutic Options for the Tricuspid Valve29:25 - Evaluating Success Rates and Patient Expectations32:27 - Right Heart Catheterization33:04 - Patient Selection Criteria34:18 - Challenges with Tricuspid Valve Procedures34:31 - Case Study: Evoke Device Size Variation35:26 - Impact of Tricuspid Annulus Rigidity37:57 - Complications and Management in Tricuspid Procedures50:00 - Financial Considerations and Reimbursement54:17 - Training and Educational Resources59:49 - Conclusion and Final Thoughts --- RESOURCES Dr. Aidan Raneyhttps://www.providence.org/doctors/interventional-cardiology/az/phoenix/aidan-raney-1962631101 Dr. Joe Walshhttps://www.saintalphonsus.org/provider/joe-walsh Coapt Study https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2018/09/21/20/12/COAPT Triluminate Study:https://www.nejm.org/doi/full/10.1056/NEJMoa2300525 Triscend Study: https://www.nejm.org/doi/full/10.1056/NEJMoa2401918

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. Sameh 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. --- SYNPOSIS Dr. 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. --- TIMESTAMPS 00:00 - Introduction 02:46 - Advancements in Structural Heart Procedures 05:38 - Intracardiac Echocardiography (ICE) Explained 09:27 - Practical Applications of ICE 13:53 - Learning and Training in ICE 17:22 - Comparing ICE Technologies 22:38 - Case Studies: ICE in Action 43:54 - Dallas PCI Conference and Closing Remarks --- RESOURCES Dr. Karim Al-Azizihttps://www.bswhealth.com/physician/karim-al-azizi Dr. Sameh Sayfohttps://www.bswhealth.com/physician/sameh-sayfo Baylor Scott & White Heart Hospital Planohttps://www.bswhealth.com/the-heart-hospital/locations/plano ICE Overviewhttps://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.031343 ICE 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