Ep. 686 Best Practices for Efficient Bone Marrow Biopsy Procedures with Dr. Mohammad Samim

The very first episode of BackTable was about bone marrow biopsies, and the procedure has come a long way since. Powered drivers, smarter planning, and a well placed periosteal block have made it faster and far more comfortable for patients. On this episode of the BackTable Podcast, Dr. Mohammad Samim, a musculoskeletal radiologist at NYU Langone Health, joins host Dr. Chris Beck to discuss best practices for image-guided bone marrow aspiration and biopsy. They discuss how more referrals are coming from hematology, what drives the need for imaging guidance, and why a careful periosteal block lets most patients avoid sedation. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Varian OmniBonehttps://cancercare.siemens-healthineers.com/products/interventional-oncology/musculoskeletal/omnibone --- Timestamps 00:00 - Introduction03:31 - Referral Trends and Procedure Volume06:15 - Indications and Contraindications12:28 - Sedation and the Periosteal Block16:30 - Procedure Walkthrough23:13 - Powered Access and Variable Speed29:43 - Sclerotic Bone and Dry Taps34:55 - Aspiration Pain and On-Site Pathology37:35 - Sternal Bone Marrow Aspiration39:07 - Efficiency With Powered Systems43:37 - Ultrasound Guidance and Workflow46:45 - Hemodilution and Repeat Biopsies48:14 - Closing Remarks --- More about this episode The conversation then walks through the procedure itself, from reviewing pelvic anatomy and planning a trajectory on the scout to choosing between a single needle and a coaxial system and aiming for a core close to 1.5 centimeters. Dr. Samim explains how variable speed powered drivers work for both soft and sclerotic bone, what to do when a needle gets stuck or a tap comes back dry, and why a slow, steady pull makes the aspirate less painful. The episode closes with workflow tips for efficiency, minimizing hemodilution, and getting a high-quality sample the first time. --- Resources Increasing Volume of Bone Marrow Biopsies by Radiology Providers: Evaluation of Trends by Physician Specialty and Practice Setting. J Am Coll Radiol. 2020https://doi.org/10.1016/j.jacr.2020.02.004 BackTable Episode 1, the very first BackTable episode, on bone marrow biopsy, with Dr. Chris Beck, Dr. Aaron Fritts, and Anish Parikhhttps://www.backtable.com/shows/vi/podcasts/1/bm-bx-devices-jamshidi-vs-oncontrol Dr. Mohammad Samim, NYU Langone Healthhttps://nyulangone.org/doctors/1487966693/mohammad-m-samim Dr. Chris Beck, BackTable contributor pagehttps://www.backtable.com/shows/vi/contributors/dr-christopher-beck --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. 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

Which patients with bleeding hemorrhoids benefit from artery embolization, and who should go to surgery instead? On this episode of the BackTable Podcast, Dr. Ally Baheti welcomes Dr. Kristen Rumer and Dr. Scott Thompson of Mayo Clinic to break down patient selection, technique, and follow-up for hemorrhoid artery embolization (HAE) at a major academic center. They explain why bleeding-predominant, Goligher grade II and III internal hemorrhoids are the best candidates, and how the technique has evolved from its origins in France to routine practice in the US. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Terumohttps://www.terumois.com/haepodcast --- Timestamps 00:00 - Introduction03:33 - Surgical Options and Recovery07:31 - Ideal Candidates for Embolization10:47 - HEMORR1 Trial Design and Embolics15:37 - Arterial Anatomy and Coil Technique19:53 - Collaboration with Colorectal Surgery24:18 - Pelvic Pain and Patient Selection28:48 - Scalability and Contraindications32:02 - Recurrence and Collateral Supply35:27 - Patient Goals and Expectations37:37 - Closing Remarks --- More about this episode The conversation covers advanced imaging, embolic selection, coil technique, and complication management. Dr. Thompson details the HEMORR1 trial protocol, including photon counting CTA, large spherical particles, and careful coil packing. Dr. Rumer discusses a bidirectional referral pathway and the unmet need for embolization options in anticoagulated and immunosuppressed patients. The episode closes with pearls for avoiding recurrence, managing chronic pelvic pain, and setting realistic expectations so patients understand what success means after HAE. --- Resources Mayo Clinic: Hemorrhoidal Embolization Trial (HEMORR1)https://www.mayo.edu/research/clinical-trials/cls-20556753 Emborrhoid: Rectal Artery Embolization for Hemorrhoid Disease (Vidal technique)https://pubmed.ncbi.nlm.nih.gov/35781988/ Rectal Artery Embolization for Hemorrhoidal Disease: Anatomy, Evaluation, and Treatment Techniques (RadioGraphics)https://pubs.rsna.org/doi/full/10.1148/rg.220014 Is the Goligher Classification a Valid Tool in Clinical Practice and Research for Hemorrhoidal Disease?https://link.springer.com/article/10.1007/s10151-022-02591-3 Scott M. Thompson, M.D., Ph.D., Mayo Clinichttps://www.mayoclinic.org/biographies/thompson-scott-m-m-d-ph-d/bio-20535376 Kristy K. Rumer, M.D., Ph.D., Mayo Clinichttps://www.mayoclinic.org/biographies/rumer-kristy-k-m-d-ph-d/bio-20519891 --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. 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 devascularize a hypervascular tumor when the vessels feeding it are too small to catheterize? On this episode of BackTable Podcast, Dr. Kavi Krishnasamy is joined by Dr. Resmi Charalel and Dr. Milan Patel to walk through seven real-world cases where non-adhesive hydrogel liquid embolics made the difference. They break down patient selection, case planning, and how to deploy these agents for safe, efficient devascularization when traditional approaches fall short. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Instyllahttps://instylla.com/embrace/ --- Timestamps 00:00 - Introduction02:23 - Liquid Embolic Use in Practice04:46 - Case 1: Renal Mass07:51 - Delivery Technique and Target Vessel Size13:08 - Device Setup and Catheter Compatibility21:57 - Case 2: Multifocal HCC27:44 - Case 3: Large Renal Tumor40:21 - Randomized Trial Outcomes43:28 - Case 4: HCC Near the Gallbladder49:39 - Case 5: Pelvic Tumor and Femoral Metastases55:30 - Lessons from Early Use and Case Selection1:01:37 - Case 6: Breast Cancer Liver Metastasis1:05:23 - Closing Remarks --- More about this episode The discussion reviews seven real-world cases, from renal and liver tumors to pelvic, bone, and breast metastases, sharing practical pearls on microcatheter selection, plug formation, controlled reflux, and navigating high-flow environments and multiple vessels. They dive into troubleshooting pitfalls like loose connections and procedural waste, the real learning curve for adopting liquid embolics, and the outcomes data that support broader adoption of these techniques. The episode closes with advice for early-career operators and a look at future directions for patients who are not candidates for other embolic therapies. --- Resources Instylla HES Hypervascular Tumor Pivotal Study (NCT04523350)https://clinicaltrials.gov/study/NCT04523350 Abi-Jaoudeh N, et al. Multicenter Randomized Trial Evaluating the Safety and Effectiveness of the Instylla Hydrogel Embolic System for Vascular Occlusion of Hypervascular Tumors. J Vasc Interv Radiol. 2026https://doi.org/10.1016/j.jvir.2026.108946 Ganguli S, Lareau R, et al. A Water-Based Liquid Embolic: Evaluation of its Safety and Efficacy in a Rabbit Kidney Model. J Vasc Interv Radiol. 2021https://doi.org/10.1016/j.jvir.2021.02.018 HALT: Embrace Hydrogel Embolic System Study of Embolization in Peripheral Arterial Bleeds (NCT05364502)https://clinicaltrials.gov/study/NCT05364502 Kim GH, et al. Effectiveness and Safety of Transarterial Radioembolization Following Inferior Phrenic Artery Glue Embolization for Flow Redistribution in Hepatocellular Carcinoma. J Vasc Interv Radiol. 2026https://doi.org/10.1016/j.jvir.2026.108784 Dr. Resmi Charalel, Montefiore Einsteinhttps://doctors.montefioreeinstein.org/providers/1558653980/resmi-charalel Dr. Milan Patel, MD Anderson Cancer Centerhttps://faculty.mdanderson.org/profiles/milan_patel.html Dr. Kavi Krishnasamy, BackTable contributor pagehttps://backtable.com/shows/vi/contributors/dr-venkatesh-krishnasamy --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

As new guidelines redefine risk stratification for pulmonary embolism (PE), emerging technologies are also changing what it means to achieve procedural success. On this episode of the BackTable Podcast, interventional radiologist Dr. Julie Bulman (BIDMC) and interventional cardiologist Dr. Jay Giri (Penn Medicine) join host Dr. Chris Beck to discuss the evolving frameworks and technologies redefining standards for catheter-directed treatment of intermediate- and high-risk PE. They discuss the role of multidisciplinary PERT teams, patient selection, the impact of new thrombectomy devices, and why autologous blood return is a growing consideration for procedural success. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Endovascular Engineering (E2)E2Helo.com --- Timestamps 00:00 - Introduction03:42 - Referral Patterns and PERT Scope05:25 - PE Workup Essentials07:26 - Targeted Assessment of Acuity11:36 - Reliability of the Walk Test14:35 - PE Treatment Pathways19:26 - Procedural Walkthrough24:15 - Catheter Sizing30:05 - Adjunct Aspiration Device Features35:09 - Blood Return Process and Safety40:03 - Helo Study Early Results45:09 - Determining Procedural Endpoints50:20 - Future Trials and Technologies53:48 - Final Thoughts and Closing Remarks --- More about this episode The discussion highlights how PERT teams use updated guidelines and thorough clinical evaluation to guide patient classification and treatment pathway selection. Dr. Bulman and Dr. Giri outline their criteria for choosing anticoagulation, catheter-directed lysis, or mechanical clot removal, and compare the techniques and learning curves for medium- versus large-bore thrombectomy devices. They explore the significance of autologous blood return during aspiration thrombectomy, noting how new reinfusion systems can reduce blood loss and influence procedural decision-making. Dr. Bulman also presents early Helo Thrombectomy System study data demonstrating the benefits of mechanized aspiration with minimal complications. The episode closes with a critical look at defining true functional procedural endpoints beyond pulmonary arterial pressures and offers a preview of upcoming trial data, such as HI-PEITHO and PEERLESS II, that could further advance PE management. --- Resources 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adultshttps://doi.org/10.1161/CIR.0000000000001415 Ultrasound-Facilitated, Catheter-Directed Thrombolysis in Intermediate-High Risk Pulmonary Embolism (HI-PEITHO)https://clinicaltrials.gov/study/NCT04790370 PEERLESS II studyhttps://clinicaltrials.gov/study/NCT06055920 Catheter-Directed Thrombolysis in Intermediate-High–Risk Pulmonary Embolism (PRAGUE-26)https://doi.org/10.1056/nejmoa2608012 Pulmonary Embolism International THrOmbolysis Study-3 (PEITHO-3)https://clinicaltrials.gov/study/NCT04430569 --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. 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 interest in genicular artery embolization grows, what does it actually take to build a sustainable GAE practice? On this episode of the BackTable Podcast, Dr. Kavi Krishnasamy is joined by Dr. Anish Ghodadra and Dr. Amin Astani to share their blueprint for building a successful genicular artery embolization (GAE) practice. They discuss patient selection, imaging workup, scoring tools, and procedural techniques, including access strategies, device choice, and embolic selection. The conversation also covers follow-up protocols, defining treatment success, and how to set patient expectations. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported byVarian https://www.siemens-healthineers.com/ --- Timestamps 00:00 - Introduction04:00 - GAE Workup and Patient Scoring05:28 - KL Score and MRI Debate10:15 - Patient Selection and Contraindications15:11 - Access Strategy and Closure Techniques19:54 - Catheters, Wires, and Embolic Choices28:19 - Cone Beam CT Workflow31:37 - Managing Collaterals34:26 - Follow-Up and Repeat GAE38:42 - Defining Success and Setting Expectations44:25 - Technique Nuances and Flow Modulation50:28 - Building Referral Networks56:56 - Keeping Referrers Engaged59:46 - Direct-to-Patient Marketing01:04:57 - Leveraging Social Media and Reviews01:12:42 - Tracking Leads and Insurance Coverage01:19:47 - Final Thoughts and Next Steps --- More about this episode Beyond technique, the discussion dives into practical strategies for growing a GAE practice: referral pathways, engaging physical therapists and orthopedic surgeons, direct-to-patient marketing, digital outreach, and tracking outcomes. The guests share experience-driven tips on handling insurance hurdles, building relationships with referring providers, and using data to demonstrate value. The episode wraps with reflections on negative trial results, the evolving landscape of GAE, and what it takes to keep a practice thriving in a competitive environment. --- Resources Long-term outcomes of genicular artery embolization for knee osteoarthritis: 12-month efficacy and secondary outcomes from a randomized sham-controlled clinical trialhttps://doi.org/10.1007/s00330-026-12505-8 Repeated Genicular Artery Embolization Using Permanent Microspheres for Severe Osteoarthritis and Postsurgical Painhttps://doi.org/10.1007/s00270-026-04410-w --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. 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 choose between thrombolysis, mechanical thrombectomy, or open surgery for acute limb ischemia, and what options remain when there’s no vessel to open? On this episode of the BackTable Podcast, host Dr. Chris Beck is joined by vascular surgeon Dr. Anahita Dua (Massachusetts General Hospital) and interventional radiologist Dr. Ripal Gandhi (Miami Cardiac and Vascular Institute) to explore treatment strategies across the full spectrum of limb ischemia. They discuss presentation and referral patterns, the imaging and exam findings that start the clock, single-session mechanical thrombectomy, the evolving role of lysis, procedural endpoints, and deep vein arterialization for chronic limb-threatening ischemia. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported byStryker Peripheral Vascularhttps://www.stryker.com/us/en/peripheral-vascular.html --- Timestamps 00:00 - Introduction02:27 - Presentation, Referral Patterns, and Imaging06:07 - Acute Limb Ischemia: Treatment Algorithm 12:16 - Thrombectomy Device Selection16:09 - Thrombolysis and Applications Beyond Lower Extremity18:46 - Procedural Endpoints, Closure, and Case Selection24:43 - Deep Vein Arterialization: Patient Selection and Planning31:25 - DVA Technique: Imaging, Anesthesia, and Access34:58 - Step-by-Step DVA Approach 41:56 - Surveillance and Managing Expectations45:59 - Wound Care and Amputation Decisions49:40 - Future Directions in PAD52:43 - Closing Remarks --- More about this episode The conversation moves from acute interventions for the cold leg, where mechanical thrombectomy has become first-line and lysis is held in reserve, to the stepwise management of no-option chronic cases, including pedal access, valve disruption, and inflow for deep vein arterialization. Drs. Dua and Gandhi share practical insights on device selection, preventing distal embolization, and when to consider open embolectomy or hybrid approaches. The episode closes with a discussion of post-procedure surveillance, wound care, and the need for better measures of perfusion to improve limb salvage and patient outcomes. --- Resources Rutherford classification of acute and chronic limb ischemia. https://doi.org/10.1016/S0741-5214(97)70045-4 Global vascular guidelines on the management of chronic limb-threatening ischemia. Conte, Bradbury, Kolh et al., Journal of Vascular Surgery, 2019. https://doi.org/10.1016/j.jvs.2019.02.016 PROMISE II. Transcatheter Arterialization of Deep Veins in Chronic Limb-Threatening Ischemia. Shishehbor et al., New England Journal of Medicine, 2023.https://doi.org/10.1056/NEJMoa2212754 BackTable VI Episode 618, How to Manage Advanced DVA Cases: Techniques and Tips, with Dr. Kumar Madassery and Dr. Sabeen Dhand. https://www.backtable.com/shows/vi/podcasts/618/how-to-manage-advanced-dva-cases-techniques-tips --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. 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

The key to personalizing Y90 may not just be treating the tumor, but understanding how much radiation a patient can tolerate, where to deliver it, and when to safely push the dose. In this episode of the BackTable Podcast, Drs. Tyler Sandow and Ryan Hickey join host Dr. Kavi Krishnasamy to explore strategies for using Y90 in hepatocellular carcinoma and liver metastases. They combine real-world data from a study of nearly 1,000 patients with insights into methodology and the many variables that influence these procedures. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by an educational grant from Boston Scientific TheraSphere Y-90. --- Timestamps 00:00 - Introduction02:36 - Resection After Radioembolization06:07 - Personal Practices Between HCC and Liver Metases07:26 - Bridging Radiation Segmentectomy 11:22 - Understanding Portal Vein Tumor Thrombus14:21 - Preferences in Dosimetry Software17:57 - Liver Reserve Limits25:11 - Microsphere Activity and Density29:16 - Diving into PROACTIF33:32 - RCTs and Trial Challenges36:57 - Patient Diversity in PROACTIF41:42 - Extrahepatic Disease43:03 - Data Gaps and Takeaways45:32 - Defining Personalized Dosimetry and Bridging Software50:15 - Mixed Delivery Approaches and Dose Thresholds01:01:36 - Response and Local Control01:04:26 - Treating PVT Subgroups01:09:03 - Comparison Between Dosing and Survival01:15:03 - Differences in Patients Quality of Life After Transplantation01:26:34 - Wrap-Up and Credits --- More about this episode The discussion covers radiation segmentectomy and selective delivery, the nuances of portal vein tumor thrombus levels, and how multidisciplinary collaboration differs between resection and transplant. The doctors dive into the PROACTIF study, focusing on personalized dosimetry, dose escalation, trial challenges, tumor response, and survival outcomes across disease stages. Drs. Sandow and Hickey also explain the limits of Y90, such as lung shunts, liver reserve, and treated liver volume, and highlight how decision-making and tailored techniques are essential for improving outcomes in liver cancer care. --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. 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 do you do when Y-90 doesn’t deliver the results you expected? In this episode of the 2026 HCC Creator Weekend™, host Dr. Tyler Sandow is joined by Drs. Beau Toskich and Juan Gimenez to discuss the technical challenges and troubleshooting strategies that can make or break a Y-90 radioembolization case. Together, they explore innovative approaches like the PREDATr technique, share tips for reducing complications, and offer guidance on optimizing outcomes for patients with complex liver tumors. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by an educational grant from Sirtex and Boston Scientific. --- Timestamps 00:00 - Introduction04:24 - Treatment Nonresponse Troubleshooting06:12 - Navigating Y90 Through Replaced Arteries09:09 - Mitigating Vasospasm in Embolization13:31 - What is ‘PREDATr’?21:12 - Dual Balloon Microcatheter System23:37 - Gelfoam Techniques and Application26:06 - Embolization Agents Preferences36:16 - Concerns with Cystic Artery Treatment and Biliary Stents42:15 - Prophylactic Antibiotics 44:29 - Utilizing High Lung Shunts49:28 - Wrap Up and Credits --- More about this episode The conversation begins with case-based examples of HCC radioembolization, focusing on how to assess treatment response and troubleshoot nonresponsive cases. They discuss how to interpret SPECT findings, identify missed tumor supply with cone-beam CT, and overcome obstacles such as vasospasm, extrahepatic feeders, and challenging arterial anatomy. They introduce the PREDATr technique (proximal radioembolization enabled by distal angiozone truncation) and explain how tools like gelfoam, balloons, and retrievable coils can preserve healthy liver tissue and improve microsphere delivery. The episode also addresses managing biliary stents, using antibiotic prophylaxis, and strategies for handling high lung shunts, making it a practical resource for anyone navigating the complexities of Y-90 treatment. --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. 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

Are new technologies and teamwork the key to better fibroid treatment? In this episode of the BackTable Podcast, Drs. Francis Kang and Neil Resnick join host Dr. Chris Beck to share how multidisciplinary treatment planning is reshaping uterine fibroid management, from patient selection and referral patterns to procedural techniques that improve outcomes. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported byTriSalus Life Scienceshttps://trinavinfusion.com/ --- Timestamps00:00 - Introduction06:18 - Multidisciplinary Care of Fibroids15:45 - Treatment Decisions21:56 - Managing Asymptomatic Fibroids25:43 - Collaborative vs. Competitive Practices30:01 - UFE Procedure Approaches34:32 - Comparing Embolic Sizes and Amounts37:44 - Changes in Speed Using TriNav Catheters40:53 - Tactile Feedback at Stasis42:28 - Embolization Target Regions44:45 - Encountering and Troubleshooting Collaterals47:30 - Post-Op Pain Regiments57:28 - Wrap Up --- More about this episodeThe conversation begins with the importance of strong partnerships with OBGYN colleagues and how multidisciplinary planning leads to better outcomes for patients. They explore patient selection and education, especially for those considering surgical versus minimally invasive treatment options. Drs. Kang and Resnick compare procedural approaches, including when to use femoral versus transradial access, nerve blocks, and embolic particle selection. They also discuss strategies to achieve optimal embolization endpoints and practical tips for handling collateral vessels, avoiding non-target embolization, and managing post-procedural pain and recovery. The episode concludes with a look at newer technologies like the TriNav Catheter and its impact on embolization speed, operator confidence, and early imaging outcomes.--- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. 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

Will new PE guidelines redefine risk and therapy in pulmonary embolism (PE) care? In this episode of the BackTable podcast, host Dr. Michael Barraza is joined by interventional cardiologist Dr. Jay Giri and emergency physician Dr. Trevor Cummings to break down the latest changes in PE management. They discuss how multidisciplinary pulmonary embolism response teams (PERT) are implementing these guidelines at their institutions, the introduction of a more nuanced A-E risk stratification system, and the challenges of enrolling experienced centers into clinical trials as device innovation accelerates. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Stryker Peripheral Vascular, formerly Inari Medicalhttps://www.inarimedical.com/flowtriever-system --- Timestamps 00:00 - Introduction 01:24 - Building a PERT Team04:59 - Trials Shaping PE Care 10:20 - Why New Guidelines Now 14:06 - New Risk Categories Explained 19:51 - Applying Guidelines Locally 23:34 - What Is C1 Risk 27:52 - New D Category Explained 30:33 - Evidence for Aggressive Therapy 33:31 - How PERT Teams Communicate 38:22 - Upcoming PE Trials Pipeline 43:42 - Program Growth and High Risk Trials 45:46 - Closing Remarks --- More about this episode The conversation highlights the growth of catheter-directed lysis and mechanical thrombectomy, the rationale and practical impact of the new Category D for incipient cardiopulmonary failure (including normotensive shock), and the incorporation of PESI, sPESI, and Hestia for risk assessment. Additional topics include decision-making for low-risk patients, lactate and biomarkers for identifying higher-risk cases, communication strategies within PERT teams, AI-enabled risk stratification, and a preview of upcoming trials (PEITHO, PRAGUE-26, PEERLESS-2, PE-TRACT, and PERSEVERE) that are set to further transform PE care. --- Resources Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension: A Scientific Statement From the American Heart Associationhttps://pubmed.ncbi.nlm.nih.gov/21422387/ Surgical Management and Mechanical Circulatory Support in High-Risk Pulmonary Embolisms: Historical Context, Current Status, and Future Directions: A Scientific Statement From the American Heart Associationhttps://pubmed.ncbi.nlm.nih.gov/36688837/ Interventional Therapies for Acute Pulmonary Embolism: Current Status and Principles for the Development of Novel Evidence: A Scientific Statement From the American Heart Associationhttps://pubmed.ncbi.nlm.nih.gov/31585051/ Ultrasound-Facilitated, Catheter-Directed Fibrinolysis for Acute Pulmonary Embolismhttps://pubmed.ncbi.nlm.nih.gov/41910345/ PEERLESS II: A Randomized Controlled Trial of Large-Bore Thrombectomy Versus Anticoagulation in Intermediate-Risk Pulmonary Embolismhttps://pubmed.ncbi.nlm.nih.gov/39132600/ Rationale and design of the PE-TRACT trial: A multicenter randomized trial to evaluate catheter-directed therapy for the treatment of intermediate-risk pulmonary embolismhttps://pubmed.ncbi.nlm.nih.gov/39638275/ Reduced-Dose Intravenous Thrombolysis for Acute Intermediate–High-risk Pulmonary Embolism: Rationale and Design of the Pulmonary Embolism International THrOmbolysis (PEITHO)-3 trialhttps://pubmed.ncbi.nlm.nih.gov/34560806/ Design and rationale of the PERSEVERE study: a randomized controlled trial of large-bore mechanical thrombectomy versus the standard of care for high-risk pulmonary embolism https://pubmed.ncbi.nlm.nih.gov/41453591/ Design and rationale of PRAGUE-26: a multicentre, randomised trial of catheter-directed thrombolysis for intermediate-high risk acute pulmonary embolismhttps://pubmed.ncbi.nlm.nih.gov/40464677/ --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. 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