Ep. 58 Renal Denervation Explained: Procedure, Guidelines, & Best Practices with Dr. Dmitriy Feldman

A creatinine of 0.9 can hide a GFR of 45, and at Columbia that gap is now called out in every cath lab time-out. On this episode of BackTable Cardiology, Dr. Sameh Sayfo talks with Dr. Megha Prasad, interventional cardiologist and co-director of the interventional cardiology fellowship at Columbia University, about the side of the cath lab most fellows are never taught: quality improvement, operations, and making the case for new technology. Dr. Prasad traces her interest back to root cause analyses during residency, explains who really defines quality, and walks through two initiatives, a contrast checkpoint to prevent acute kidney injury and a standardized weaning protocol for mechanical circulatory support. She also explains why awareness and an operator's own data move colleagues more than penalties, and how fellows can become a lab's standard keepers. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by an educational grant from Chiesi. --- Timestamps 00:00 - Introduction03:10 - From Root Cause Analysis to Quality Improvement05:20 - Who Defines Quality in the Cath Lab?07:50 - A Time-Out Checkpoint to Prevent Contrast-Associated AKI11:55 - Winning Buy-In Without Penalties16:04 - Engaging Fellows in Quality Improvement21:04 - When Quality Metrics Go Too Far27:30 - Cath Lab Turnover and Team Morale33:02 - Building a Culture of Respect in the Cath Lab41:45 - Learning to Talk With Hospital Administration45:54 - Making the Case for New Therapies51:28 - Closing Remarks --- More about this episode The doctors then discuss what happens when quality metrics go too far: public reporting that can push operators away from the most complex patients, and why Dr. Prasad thinks interventionalists, like artists, must choose which outside feedback to take. She describes how team morale drives cath lab turnover, why a hierarchical cath lab is a dangerous one, and how physicians can learn the art of negotiation with hospital administration. They close on leaving ego at the door, backing every request for a new therapy with data, and how patients informed by AI are changing the conversation. --- Resources Dr. Megha Prasad, Columbia University Department of Medicine, Division of Cardiology profilehttps://www.columbiacardiology.org/profile/megha-prasad-md NCDR CathPCI Registry, American College of Cardiologyhttps://cvquality.acc.org/NCDR-Home/registries/hospital-registries/cathpci-registry --- 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

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 apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction02:42 - Guideline Recommendations for Renal Denervation05:36 - Lessons From Early Sham-Controlled Trials12:15 - Referral Pathways and Hypertension Programs17:16 - Pre-Procedural Workup and Imaging23:11 - Patient Selection and Counseling29:09 - Durability of Blood Pressure Reduction31:46 - Radiofrequency Denervation Technique42:44 - Ultrasound Denervation Technique45:38 - Sedation and Pain Management49:06 - Complication Management53:10 - Future Directions in Denervation58:05 - 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. 2025https://doi.org/10.1161/HYP.0000000000000249 Position Statement on Renal Denervation for Hypertension: Patient Selection, Operator Competence, Training and Techniques, and Organizational Recommendations. JSCAI. 2023https://doi.org/10.1016/j.jscai.2023.101121 A Controlled Trial of Renal Denervation for Resistant Hypertension (SYMPLICITY HTN-3). N Engl J Med. 2014https://doi.org/10.1056/NEJMoa1402670 Efficacy of Catheter-Based Renal Denervation in the Absence of Antihypertensive Medications (SPYRAL HTN-OFF MED Pivotal). Lancet. 2020https://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. 2022https://doi.org/10.1016/S0140-6736(22)00455-X Endovascular Ultrasound Renal Denervation to Treat Hypertension (RADIANCE II). JAMA. 2023https://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. 2019https://doi.org/10.1161/CIRCULATIONAHA.118.037654 American Heart Association. Hypertension Center Certificationhttps://www.heart.org/HypertensionCertification BackTable Cardiology: Renal Denervation: Innovations in Hypertension Managementhttps://www.backtable.com/shows/cardiology/podcasts/26/renal-denervation-innovations-in-hypertension-management Dr. Dmitriy Feldman, Weill Cornell Medicinehttps://weillcornell.org/dnfeldman Dr. Vladimir Lakhter, BackTable contributor pagehttps://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 apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction02:30 - Mechanism of Cutting and Scoring Balloons06:13 - Superficial Calcium and Balloon Undersizing08:39 - Focal Force and Calcium Fracture11:35 - Device Selection and Lesion Length15:46 - In-Stent Restenosis, Drug-Coated Balloons and Ostial Lesions19:52 - Procedural Sequence and Balloon Sizing24:18 - Sizing Without Imaging and Multiple Inflations26:43 - Enhanced Stent Visualization as a Procedural Endpoint29:29 - Complications and Branch Vessel Safety33:14 - Hematoma Fenestration in Dissection and SCAD37:30 - 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. 2023https://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/NCT06089135Intravascular Ultrasound-Derived Calcium Score to Predict Stent Expansion in Severely Calcified Lesions. Circ Cardiovasc Interv. 2021https://doi.org/10.1161/CIRCINTERVENTIONS.120.010296 A New Optical Coherence Tomography-Based Calcium Scoring System to Predict Stent Underexpansion. EuroIntervention. 2018https://doi.org/10.4244/EIJ-D-17-00962 BackTable Cardiology Episode 14. COSIRA II: Refractory Angina Challenges & Treatment Strategies, with Dr. Ziad Alihttps://www.backtable.com/shows/cardiology/podcasts/14/cosira-ii-refractory-angina-challenges-treatment-strategies Dr. Ziad Ali, Catholic Health physician profilehttps://doctors.catholichealthli.org/provider/ziad-anwar-ali/2404986 Dr. Nyal Borges, Atrium Health physician profilehttps://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 apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction02:48 - Procedural Setup and Vascular Access06:31 - Sheath in Sheath Technique11:20 - Guide Catheter Selection17:53 - Wire Selection and Balloon Undersizing22:12 - Crossing Chronic Total Occlusions27:25 - Pulmonary Collaterals and Flush Occlusions32:33 - Guide Extensions and Contrast Reduction36:38 - Distal Perfusion Pressure Targets41:26 - Pressure Wire Selection and Wire Management45:54 - Balloon Sizing and Reperfusion Pulmonary Edema54:04 - Hemoptysis and Gelatin Sponge Embolization1:02:32 - 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. 2012https://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. 2026https://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. 2025https://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. 2025https://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. 2024https://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. 2013https://doi.org/10.1016/j.jcin.2013.03.009 BackTable Cardiology Episode 36. Understanding CTEPH, Diagnostic and Interventional Techniqueshttps://www.backtable.com/shows/cardiology/podcasts/36/understanding-cteph-diagnostic-interventional-techniques Dr. Riyaz Bashir, Mayo Clinic, Jacksonvillehttps://www.mayoclinic.org/biographies/bashir-riyaz-m-b-b-s-m-d/bio-20590757 Dr. Hady Lichaa, BackTable contributor pagehttps://backtable.com/shows/vi/contributors/dr-hady-lichaa Dr. Hady Lichaa, Ascension Saint Thomas Hearthttps://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 apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction04:52 - Why Pursue an MBA08:06 - Choosing the Right Program11:15 - Building a Cardiovascular Center on Aging14:54 - Balancing Clinical Work and Business School18:48 - Focusing on Finance and Analytics23:27 - Evaluating Programs and Medical Devices29:47 - Reimbursement and Training Implications33:05 - MBA Return on Investment and Opportunity Cost36:28 - Who Should Consider an MBA46:20 - Artificial Intelligence and Business Education50:53 - The MBA’s Impact on Cardiology54:33 - 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 Profilehttps://www.getcare.hackensackmeridianhealth.org/provider/ankitkumar-kirankumar-patel/1316247 Dr. Abdulla A. Damluji’s Physician Profilehttps://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 apphttps://www.backtable.com/app --- This podcast is supported by RADPAD® Radiation Protectionhttps://www.radpad.com/ --- Timestamps 00:00 - Introduction04:00 - Three Key Indications for UHP Balloons05:09 - Balloon Design, Material and Crossing Profile07:32 - Intravascular Imaging and Case Planning11:09 - Wire Compatibility and Buddy Wiring13:55 - Calcium Morphology and Device Selection17:43 - In-Stent Restenosis and Non-Dilatable Stents20:33 - Sizing, Inflation Technique and Indeflators28:21 - Post-Treatment Imaging and Calcium Fracture31:16 - Perforation, Balloon Rupture and Dissection Risk38:03 - Cost and Procedural Control40:20 - Future Calcium Modification Technologies41:37 - Closing Remarks --- More about this episode The conversation covers IVUS-led planning, device selection for different calcium morphologies, inflation strategies, and practical tips to avoid complications like rupture or dissection. Dr. Kapoor shares his approach to in-stent restenosis, cost considerations, and what the future may hold for calcium modification. The conversation closes with advice for operators new to UHP balloons, the importance of post-procedure imaging, and how to stay safe when pushing past traditional pressure limits. --- Resources Very high-pressure dilatation for undilatable coronary lesions: indications and results with a new dedicated balloon (EuroIntervention, 2016)https://pubmed.ncbi.nlm.nih.gov/26111405/ Super high-pressure balloon versus scoring balloon to prepare severely calcified coronary lesions: the ISAR-CALC randomised trial (EuroIntervention, 2021)https://pubmed.ncbi.nlm.nih.gov/33258774/ Safety and efficacy of super-high pressure OPN balloon in patients with in-stent restenosis, an intracoronary imaging-based observational study (Scientific Reports, 2025)https://www.nature.com/articles/s41598-025-20488-7 VICTORY: intravascular lithotripsy versus super-high-pressure balloons in calcified and refractory coronary lesions (PCR, TCT 2025)https://www.pcronline.com/News/Congress-coverages/TCT/2025/VICTORY-Intravascular-lithotripsy-vs.-super-high-pressure-PTCA-in-calcified-and-refractory-coronary-lesions --- BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

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

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

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

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