Ep. 40 Maximizing Success in CTO Procedures with CT Imaging with Dr. Anbukarasi Maran

Ep. 40 Maximizing Success in CTO Procedures with CT Imaging with Dr. Anbukarasi Maran

Can cardiac CTA take the guesswork out of complex CTO (chronic total occlusion) procedures? In this episode of Backtable Cardiology, host Dr. Hady Lichaa interviews interventional cardiologist and CTO operator Dr. Anbukarasi Maran about how advanced CT imaging is changing the landscape of CTO PCI (percutaneous coronary intervention) planning. They discuss workflow for integrating photon-counting CT, collaboration with radiologists, and why this approach is being adopted for pre-procedure planning in CTO cases, reflecting its growing use in structural heart interventions. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 03:04 - Why CTA for CTO 05:24 - CTA Workflow and Photon Counting 07:15 - Key CTA Findings for Strategy 12:12 - In Lab CTA Overlay Case Example 15:20 - Planning for All Operators 17:07 - Guide Selection and Efficiency 18:23 - Reading CTA and Teamwork 22:46 - Photon Counting for Stents 24:01 - Limitations Kidney Rate BMI 31:13 - Building a CTA Program 33:26 - Wrap Up and Credits --- More about this episode Dr. Maran describes a workflow using photon-counting CT, when available, to reduce calcium blooming and to better assess plaque and stents. She emphasizes close collaboration with radiologists for 3D reconstruction, vessel course mapping, calcification patterns, landing zones, collateral selection, and resolving proximal cap ambiguity. Dr. Maran notes that CTA can reduce repeat diagnostic catheterizations, improve time efficiency, guide device selection, and help anticipate the need for calcium-modifying tools, while not replacing intravascular imaging. Limitations discussed include renal function (avoiding CTA when creatinine is greater than two), occasional misleading findings in heavy calcium, heart-rate control challenges, and high BMI affecting image quality. She advises launching programs through multidisciplinary champions, administrative value framing, and careful reimbursement planning. --- Resources Dr. Anbukarasi Maran https://www.getcare.muschealth.org/providers/anbukarasi-maran-1861579112 --- BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Ep. 39 Integrating APPs in Cardiology Clinical Practice with Hallie McNew, NP

How are advanced practice providers (APPs) helping to elevate cardiovascular care? In this episode of BackTable Cardiology, Dr. Sameh Sayfo, an interventional cardiologist at Baylor Scott & White in Dallas, interviews nurse practitioner Hallie McNew about her journey from bedside ICU nursing to leading roles in cardiac surgery and structural heart practice. They discuss the unique strengths APPs bring to cardiology teams, differences between NPs and PAs, and highlight how prior nursing experience, mentorship, and structured onboarding can elevate quality of care, efficiency, and communication for cardiac patients. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 06:54 - APP as a Communication Bridge 10:34 - Training New Cardiology APPs 15:12 - Day In Structural Surgery Role 17:55 - Learning Imaging And EKG Skills 21:44 - Conferences and Continuing Education 27:59 - Building APP Communities And Programs 33:52 - Outpatient Hybrid Models And Hiring 39:11 - Billing Value and Patient Trust 42:03 - Handling Difficult Patient Conversations 47:27 - Wrap Up and Credits --- More about this episode The conversation also covers best practices for orienting and mentoring new APPs, APP-led services, and the importance of learning to interpret primary data such as CT, ECHO, and EKG results. McNew shares insights on continuing education resources, including ACC subspecialty training, Mayo Clinic courses, and national meetings, plus strategies for building strong APP communities, optimizing staffing and billing models, and ways physicians and APPs can build patient trust. They also address the value of physician-APP partnerships, flexible scheduling, and the keys to creating true continuity from the hospital to the outpatient setting. --- Resources VIVA Conference https://viva-foundation.org/ CRT Conference https://crtmeeting.org/ TCT Conference https://www.tctconference.com/ Dr. Sameh Sayfo https://www.bswhealth.com/physician/sameh-sayfo --- BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Ep. 38 Advances in PE Treatment Guidelines with Dr. Jay Giri and Dr. Trevor Cummings

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 app https://www.backtable.com/app --- This podcast is supported by Stryker Peripheral Vascular, formerly Inari Medical https://www.inarimedical.com/flowtriever-system --- Timestamps 00:00 - Introduction 01:24 - Building a PERT Team 04:59 - 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 Association https://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 Association https://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 Association https://pubmed.ncbi.nlm.nih.gov/31585051/ Ultrasound-Facilitated, Catheter-Directed Fibrinolysis for Acute Pulmonary Embolism https://pubmed.ncbi.nlm.nih.gov/41910345/ PEERLESS II: A Randomized Controlled Trial of Large-Bore Thrombectomy Versus Anticoagulation in Intermediate-Risk Pulmonary Embolism https://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 embolism https://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 trial https://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 embolism https://pubmed.ncbi.nlm.nih.gov/40464677/ --- 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

Ep. 37 Breaking Down the New Pulmonary Embolism Guidelines with Dr. Sanjum Sethi

Are the latest pulmonary embolism guidelines changing how you risk-stratify and intervene on acute PE? In this episode of BackTable Cardiology, host Dr. Hady Lichaa interviews Dr. Sanjum Sethi of Columbia University Medical Center about the evolving management of pulmonary embolism (PE) and the major updates reflected in the newest guidelines. They review the new A–E risk classification system, key updates to systemic thrombolysis recommendations, and the expanding role of catheter-based therapies as randomized evidence emerges, highlighting how these changes are shaping PERT protocols, influencing clinical decision-making, and affecting patient outcomes. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 01:40 - Major Guideline Changes 13:26 - Essential Components of PERT Calls 16:38 - Assessing Clot Burden 24:32 - When To Prioritize Surgical Management 30:15 - Importance of RV Function 31:26 - Heparin Versus LMWH 37:58 - TPA Dosing 43:42 - Thrombectomy Devices And Guidelines 50:19 - Future Technology --- More about this episode The doctors discuss key practice updates, including the new Class I recommendation to incorporate lactate into shock assessment and the downgrade of systemic thrombolysis for highest-risk PE patients while highlighting the expanding evidence and indications for catheter-based therapies. Dr. Sethi outlines the essential clinical data to gather during PERT calls, including vital signs, RV function, biomarkers, and patient goals, and explains why relying solely on CT thrombus burden can be misleading. They discuss the importance of echocardiography for detecting findings like PFO or clot-in-transit and provide guidance on when to consider surgical intervention or ECMO, how to choose between heparin and LMWH, and the nuanced decision-making behind selecting catheter-directed thrombolysis versus mechanical thrombectomy. --- Resources Dr. Hady Lichaa’s Provider Profile https://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa Dr. Sanjum Sethi’s Provider Profile https://www.columbiacardiology.org/profile/sanjum-s-sethi-md-mph 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults https://www.ahajournals.org/doi/10.1161/CIR.0000000000001415?utm_campaign=sciencenews25-26&utm_source=science-news&utm_medium=phd-link&utm_content=phd-2-19-26 Pharmacomechanical Catheter-Directed Thrombolysis With the Bashir Endovascular Catheter for Acute Pulmonary Embolism: The RESCUE Study https://www.jacc.org/doi/10.1016/j.jcin.2022.09.011 --- 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

Ep. 36 Understanding CTEPH Diagnostic & Interventional Techniques with Dr. Vladimir Lakhter

Could persistent dyspnea after a “resolved” PE be more than just deconditioning or diastolic dysfunction? In this episode of BackTable Cardiology, Dr. Hady Lichaa hosts interventional cardiologist and vascular medicine specialist Dr. Vladimir Lakhter, to discuss the diagnosis and management of CTEPH and chronic thromboembolic disease (CTED). They review the prevalence of CTEPH following pulmonary embolism, common delays in diagnosis, and why symptoms such as dyspnea are often misattributed to conditions like diastolic dysfunction. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 02:40 - Defining CTEPH 07:00 - Diagnostics for Detection 12:02 - Treatment Considerations 16:08 - Anatomy Challenges 22:03 - Device Options and Techniques 29:40 - BPA Procedure 39:50 - Interpreting Angiographic Appearance of CTEPH 48:10 - BPA Challenges and Risks 52:06 - Diuretics 55:10 - Post BPA Diagnostics and Complications 01:02:42 - Treatment Endpoints 01:06:10 - Continuing Education and Expert Resources 01:08:41 - Closing Thoughts --- More about this episode Dr. Lakhter outlines a practical diagnostic workup, emphasizing the Ventilation-Perfusion (V/Q) scan as the key screening test, supplemented by thin-cut CT pulmonary angiography and transthoracic echocardiography (TTE). He then explains how treatment decisions are made within a multidisciplinary framework, balancing medical therapy, surgical pulmonary endarterectomy (the curative gold standard for surgically accessible disease), and balloon pulmonary angioplasty (BPA) for patients with distal disease, residual pulmonary hypertension after surgery, or those who are not surgical candidates. Drs. Lichaa and Lakhter dive into a detailed procedural overview of BPA, including pulmonary artery anatomy resources, pulmonary angiography technique, access and equipment selection, lesion classification, and intraprocedural assessment using pressure wires and venous return patterns. Dr. Lakhter shares practical strategies to minimize complications, including undersized balloon sizing to reduce reperfusion pulmonary edema, routine post-procedure diuresis, and management of complications such as pulmonary artery injury and tamponade using Gelfoam, coils, and, in rare cases, vascular plugs. They finish the conversation with a closer look at typical BPA staging and treatment endpoints. --- Resources Dr. Hady Lichaa’s Provider Profile https://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa Dr. Vladimir Lakhter’s Provider Profile https://www.templehealth.org/doctors/vladimir-lakhter Balloon Pulmonary Angioplasty (BPA) for Treatment of Chronic Thromboembolic Pulmonary Hypertension (CTEPH) https://pubmed.ncbi.nlm.nih.gov/11136677/ --- 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