Ep. 32 Coronary Microvascular Dysfunction: Optimizing Diagnosis & Management with Dr. Samit Shah

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

Ep. 35 Interventional Cardiology Insights: A Journey with Innovations with Dr. Bill O’Neill

What do the very first TAVRs, rotational atherectomies, and angioplasty studies have in common? Dr. William O’Neill, an esteemed interventional cardiologist whose collaboration and innovation have shaped the field of interventional cardiology. In this episode of BackTable Cardiology, host Dr. Babar Basir welcomes his mentor Dr. William O’Neill. Together, they trace the evolution of interventional cardiology through personal stories, groundbreaking research, and the lasting impact of mentorship and teamwork on the specialty’s past, present, and future. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 11:49 - Intracoronary Streptokinase Breakthrough 14:28 - Birth of Angioplasty: Initial Studies 23:20 - Primary PCI Proves Itself 28:29 - TAVR Breakthroughs 35:32 - Mentorship Lessons 40:17 - Future Cardiology Frontiers 46:22 - Presidential Heart History 53:51 - Conclusion --- More about this episode Dr. O’Neill details the evolution from bedrest-era MI care to intracoronary streptokinase and the advent of reperfusion, his early exposure to balloon angioplasty, and the pivotal studies that proved primary PCI’s superiority over thrombolytics amidst controversy. He explores how physician–engineer collaboration enabled innovations such as aortic valvuloplasty and early US TAVR, including the procedural challenges and regulatory hurdles faced. The episode also covers Dr. O’Neill’s mentorship philosophy, his optimism for the future of cardiology, including breakthroughs in cardiomyogenesis, xenotransplantation, and denervation therapies and his plan to remain up-to-date in the cardiology scene while beginning research on past presidents’ heart disease. --- Resources Dr. Babar Basir’s physician profile https://www.scai.org/mir-b-basir-do-fscai Dr. William O’Neill’s physician profile https://www.scai.org/william-w-oneill-md-mscai Thrombolysis and angioplasty in myocardial infarction (TAMI) trial https://www.jacc.org/doi/10.1016/S0735-1097%2887%2980430-8 Thrombolysis in Myocardial Infarction (TIMI) Study Group https://timi.org/about-timi/ Health-related quality of life one month after thrombolysis or primary PCI in patients with ST-elevation infarction. A DANAMI-2 sub-study. https://www.tandfonline.com/doi/10.1080/14017430510035989?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Patient age and results of balloon aortic valvuloplasty: The mansfield scientific registry experience https://www.sciencedirect.com/science/article/pii/0735109791908738 Percutaneous Transcatheter Implantation of an Aortic Valve Prosthesis for Calcific Aortic Stenosis: First Human Case Description https://www.ahajournals.org/doi/10.1161/01.CIR.0000047200.36165.B8 Primary left ventricular unloading with delayed reperfusion in patients with anterior ST-elevation myocardial infarction: Rationale and design of the STEMI-DTU randomized pivotal trial https://pubmed.ncbi.nlm.nih.gov/36058253/ --- 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. 34 Understanding Cardiac Mass Removal: Techniques Using Continuous Aspiration with Dr. Abdallah El Sabbagh

From clot to clear flow, minimally invasive aspiration devices are PAVE-ing the way for safer treatment of endocarditis and cardiac masses. In this BackTable Cardiology episode, host Dr. Hady Lichaa sits down with Dr. Abdallah El Sabbagh to discuss percutaneous continuous-flow aspiration for right- and select left-sided endocarditis and cardiac masses. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by Angiodynamics https://9zfaiv.short.gy/cardiovascular-backtable --- Timestamps 00:00 - Introduction 03:43 - Lessons in Fibroelastoma 12:01 - Imaging Workup 14:24 - Transesophageal Echocardiography (TEE) vs Intracardiac Echocardiography (ICE) 17:52 - AngioVac System Components 20:33 - Access Strategy, Sheath Size and Flow Rates 23:41 - Adjunct Tools and Retrieval Options 31:35 - Using Continuous Aspiration 47:16 - Percutaneous AngioVac Vegetation Extraction (PAVE) Trial 53:17 - Future Devices Wishlist --- More about this episode Dr. El Sabbagh provides guidance on removing papillary fibroelastomas, emphasizing matching technique to mass characteristics and combining tools such as continuous aspiration with electrosurgical snaring to address adherent stalks. Their conversation covers patient selection for off-label endocarditis intervention, including intravenous drug use and Cardiac Implantable Electronic Device (CIED) lead infections, use of aspiration as definitive therapy, and imaging/workflow preferences. Dr. El Sabbagh details the AngioVac system, access strategies, adjunct devices, mitigating complications, and registry outcomes. He touches on the need for prospective studies, including the Percutaneous AngioVac Vegetation Extraction (PAVE) clinical trial. To finish the conversation, Drs. Lichaa and El Sabbagh look ahead to building future devices and provide advice on creating multidisciplinary programs as well as training pathways. --- Resources Dr. Hady Lichaa’s Provider Profile https://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa Dr. Abdallah El Sabbagh’s Provider Profile https://www.mayoclinic.org/biographies/el-sabbagh-abdallah-m-d/bio-20466764 Percutaneous AngioVac Vegetation Extraction (PAVE) to Remove Right Heart Vegetations in Patients With Infective Endocarditis - PAVE Clinical Trial https://clinicaltrials.gov/study/NCT07282002 --- 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. 33 CLTI: Lithotripsy and Endovascular Techniques for Below the Knee Interventions with Dr. Paul Foley

Below-the-knee (BTK) arterial disease remains one of the more challenging areas in vascular care, particularly in patients with chronic limb-threatening ischemia (CLTI), where heavy calcification complicates endovascular treatment. As new calcium-modifying technologies emerge, an important question remains: what evidence supports their use in BTK interventions? In this episode of BackTable Vascular & Interventional, host Dr. Sabeen Dhand speaks with vascular surgeon Dr. Paul Foley of Doylestown Health about the Disrupt BTK II clinical trial from Shockwave Medical, which evaluates the performance of peripheral intravascular lithotripsy (IVL) in heavily calcified BTK disease. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by Shockwave Medical https://shockwavemedical.com/ --- Timestamps 00:00 - Introduction 08:20 - Evolution of Below-the-Knee Treatments 11:10 - Differences in BTK Calcification 13:13 - Imaging and Technology in BTK Interventions 15:18 - Disrupt BTK II Trial Data and Results 23:17 - Introduction to the Javelin Device 26:39 - Technique Considerations with Javelin 28:36 - Comparing Javelin and E8 31:17 - Future Directions for Lithotripsy Technology 35:30 - Skepticism Around IVL in BTK Disease 38:47 - Final Thoughts --- More about this episode Dr. Foley begins by outlining his training and the evolution of his vascular surgery practice, setting the stage for a broader discussion on how BTK interventions have changed over the past decade. The conversation explores shifts in access strategies, procedural approaches, and the unique characteristics of calcification encountered in CLTI. Because BTK calcium differs from calcification seen elsewhere in the peripheral vasculature, imaging and device selection play a particularly important role when planning IVL-based therapies. Dr. Foley reviews the design and outcomes of the Disrupt BTK II trial, where devices such as the Shockwave M5+ and S4 catheters were used to modify calcified plaque, demonstrating encouraging safety and performance signals. The discussion then turns to emerging technologies, including Shockwave’s Javelin catheter, designed to deliver focused pressure waves to fracture dense calcium within peripheral arteries. Dr. Foley describes how the device fits into BTK workflows, including technique considerations and its use alongside adjunctive therapies such as balloon angioplasty. The episode also addresses the ongoing skepticism surrounding IVL in BTK disease, emphasizing the need for careful patient selection, procedural precision, and continued multidisciplinary collaboration as the field works to refine treatment strategies and improve outcomes for patients with peripheral artery disease (PAD). --- Resources Disrupt BTK II Trial https://www.jvascsurg.org/article/S0741-5214(24)02063-9/fulltext --- 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. 32 Coronary Microvascular Dysfunction: Optimizing Diagnosis & Management with Dr. Samit Shah

Small vessels can have a major impact. Are you missing the hidden culprit of chest pain? In this episode of BackTable Cardiology, host Dr. Hady Lichaa welcomes Yale Interventional Cardiologist Dr. Samit Shah to discuss Coronary Microvascular Dysfunction (CMD) and Angina with No Obstructive Coronary Arteries (ANOCA). Their discussion demonstrates how coronary function testing turns a historically vague diagnosis into actionable phenotyping that can dramatically improve treatment efficacy and patient symptoms. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 01:53 - Coronary Microvascular Dysfunction (CMD) Overview 10:55 - Cath Lab Workflow Tips 19:28 - Structural CMD: Discordant CFR and IMR Values 26:59 - Vasospastic Phenotypes 28:28 - Chest Pain Case: Syncope and Arrest Risk 33:31 - Treatment and ACh Testing 39:10 - Mixed Physiology Pharmacotherapy 49:45 - Myocardial Bridge Workup 55:19 - Workflow, Reimbursement, and Future Therapies 58:11 - Closing and Signoff --- More about this episode Dr. Shah breaks down clinical presentations and cath lab findings of epicardial vasospasm, microvascular spasm, and endothelial dysfunction, outlining how phenotype and physiology influence treatment. He explains how to perform both Coronary Flow Reserve (CFR) and Index of Microcirculatory Resistance (IMR) testing, incorporating examples of interpretation of abnormal values. The physicians discuss COVADIS criteria for vasospastic angina, vasospasm and cardiac arrest considerations, and myocardial bridges in LAD-PCI. The episode covers door-to-discharge care for CMD: identification of phenotype via patient case walk-throughs, practical cath lab workflow, and recommendations for tailored pharmacotherapy. --- Resources Dr. Hady Lichaa’s Provider Profile https://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa Dr. Samit Shah’s Provider Profile https://medicine.yale.edu/profile/samit-shah/ COVADIS Criteria for vasospastic angina https://covadis.online/definitions/ A doppler flow probe for canine main left coronary arteries https://journals.physiology.org/doi/abs/10.1152/jappl.1974.37.2.256?journalCode=jappl ChaMP-CMD: A Phenotype-Blinded, Randomized Controlled, Cross-Over Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.066680 Presence and Relevance of Myocardial Bridge in LAD-PCI of CTO and Non-CTO Lesions https://pubmed.ncbi.nlm.nih.gov/38340105/ DEFINE GPS Trial https://clinicaltrials.gov/study/NCT04451044 --- 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