Backtable Cardiology

Epizode

• Ep. 37 Breaking Down the New Pulmonary Embolism Guidelines with Dr. Sanjum Sethi 02.06.2026 56min

  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 apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction01:40 - Major Guideline Changes 13:26 - Essential Components of PERT Calls16:38 - Assessing Clot Burden24:32 - When To Prioritize Surgical Management30:15 - Importance of RV Function 31:26 - Heparin Versus LMWH 37:58 - TPA Dosing 43:42 - Thrombectomy Devices And Guidelines50:19 - 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 Profilehttps://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa Dr. Sanjum Sethi’s Provider Profilehttps://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 Adultshttps://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 26.05.2026 1h 10min

  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 apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction02:40 - Defining CTEPH07:00 - Diagnostics for Detection12:02 - Treatment Considerations16:08 - Anatomy Challenges22:03 - Device Options and Techniques29:40 - BPA Procedure39:50 - Interpreting Angiographic Appearance of CTEPH48:10 - BPA Challenges and Risks52:06 - Diuretics 55:10 - Post BPA Diagnostics and Complications01:02:42 - Treatment Endpoints01:06:10 - Continuing Education and Expert Resources01:08:41 - 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 Profilehttps://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa Dr. Vladimir Lakhter’s Provider Profilehttps://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 12.05.2026 56min

  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 apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction11:49 - Intracoronary Streptokinase Breakthrough14:28 - Birth of Angioplasty: Initial Studies23:20 - Primary PCI Proves Itself28:29 - TAVR Breakthroughs35:32 - Mentorship Lessons40:17 - Future Cardiology Frontiers46:22 - Presidential Heart History53:51 - 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 profilehttps://www.scai.org/mir-b-basir-do-fscai Dr. William O’Neill’s physician profilehttps://www.scai.org/william-w-oneill-md-mscai Thrombolysis and angioplasty in myocardial infarction (TAMI) trialhttps://www.jacc.org/doi/10.1016/S0735-1097%2887%2980430-8 Thrombolysis in Myocardial Infarction (TIMI) Study Grouphttps://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 Descriptionhttps://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 trialhttps://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 05.05.2026 57min

  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 apphttps://www.backtable.com/app --- This podcast is supported by Angiodynamicshttps://9zfaiv.short.gy/cardiovascular-backtable --- Timestamps 00:00 - Introduction03:43 - Lessons in Fibroelastoma 12:01 - Imaging Workup14:24 - Transesophageal Echocardiography (TEE) vs Intracardiac Echocardiography (ICE)17:52 - AngioVac System Components20:33 - Access Strategy, Sheath Size and Flow Rates23:41 - Adjunct Tools and Retrieval Options31:35 - Using Continuous Aspiration47:16 - 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 Profilehttps://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa Dr. Abdallah El Sabbagh’s Provider Profilehttps://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 Trialhttps://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 28.04.2026 43min

  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 apphttps://www.backtable.com/app --- This podcast is supported by Shockwave Medicalhttps://shockwavemedical.com/ --- Timestamps 00:00 - Introduction08:20 - Evolution of Below-the-Knee Treatments11:10 - Differences in BTK Calcification13:13 - Imaging and Technology in BTK Interventions15:18 - Disrupt BTK II Trial Data and Results23:17 - Introduction to the Javelin Device26:39 - Technique Considerations with Javelin28:36 - Comparing Javelin and E831:17 - Future Directions for Lithotripsy Technology35:30 - Skepticism Around IVL in BTK Disease38:47 - 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 Trialhttps://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 21.04.2026 1h

  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 apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction01:53 - Coronary Microvascular Dysfunction (CMD) Overview10:55 - Cath Lab Workflow Tips19:28 - Structural CMD: Discordant CFR and IMR Values26:59 - Vasospastic Phenotypes28:28 - Chest Pain Case: Syncope and Arrest Risk33:31 - Treatment and ACh Testing39:10 - Mixed Physiology Pharmacotherapy49:45 - Myocardial Bridge Workup55:19 - Workflow, Reimbursement, and Future Therapies58:11 - 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 Profilehttps://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 anginahttps://covadis.online/definitions/ A doppler flow probe for canine main left coronary arterieshttps://journals.physiology.org/doi/abs/10.1152/jappl.1974.37.2.256?journalCode=jappl ChaMP-CMD: A Phenotype-Blinded, Randomized Controlled, Cross-Over Trialhttps://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 Trialhttps://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
• BackTable Brief: COSIRA II: Coronary Sinus Reducer: A Tool in Angina Care with Dr. Jai Khatri 14.04.2026 23min

  Summary This week, the coronary sinus isn’t the only thing getting reduced! Dr. Jai Khatri and Dr. Ziad Ali join this BackTable Brief to share strategies for reducing enrollment barriers for the COSIRA II coronary sinus reducer trial. They discuss refractory angina, emerging evidence for microvascular angina, and strategies to help patients achieve stable medical therapy and avoid resetting trial eligibility. TIMESTAMPS 00:00 - Introduction 01:46 - Maintaining Patients Eligibility 04:20 - Treadmill Test Reproducibility 07:16 - Patient Stories And Outcomes 11:39 - CTO vs. COSIRA-II Trial Candidacy 16:57 - Microvascular Angina: Evidence and Outlook CHECK OUT THE FULL EPISODE COSIRA II: Managing Refractory Angina in Clinical Practice https://www.backtable.com/shows/cardiology/podcasts/14/cosira-ii-refractory-angina-challenges-treatment-strategies RESOURCES COSIRA-II Trialhttps://clinicaltrials.gov/study/NCT05102019
• BackTable Brief: COSIRA II: Managing Refractory Angina in Clinical Practice with Dr. Jai Khatri 07.04.2026 22min

  Coronary sinus reducers: the hourglass-shaped stents that might be able to take patients back to angina-free times. In this BackTable Cardiology Brief, Dr. Jai Khatri and Dr. Ziad Ali discuss patient selection, treatment algorithms, and recent, clinical-trial backed technology for treating diffuse, multi-vessel atherosclerotic disease. They emphasize staged PCI, careful counseling, and setting realistic expectations when angiographic success doesn’t translate to symptom relief. Notably, the episode introduces the coronary sinus reducer, tracing the stent’s roots back to the Beck procedure of the 1950s. Drs. Jai and Khatri review the stent’s mechanism in the coronary sinus and review key coronary sinus reducer trials: COSIRA and COSIRA-II. The delve into COSIRA-II’s design, inclusion criteria, and best practices and recommendations for enrolling patients. --- Timestamps 00:00 - Introduction 00:59 - Diffuse Disease Challenges 02:42 - Patient Communication: Setting Expectations 05:06 - Treatment Algorithms: PCI vs CABG 07:22 - When PCI Fails Symptoms 08:35 - Coronary Sinus Reducers 10:52 - COSIRA Evidence 12:01 - COSIRA II Design 13:13 - Why Sham Control Matters 14:30 - Reducer Procedure Walkthrough 16:54 - Risks And Safety 18:41 - Enrollment And Criteria 20:11 - Wrap Up And Credits --- Check out the full episode COSIRA II: Managing Refractory Angina in Clinical Practice https://www.backtable.com/shows/cardiology/podcasts/14/cosira-ii-refractory-angina-challenges-treatment-strategies --- Resources COSIRA-II Trial https://clinicaltrials.gov/study/NCT05102019
• Ep. 31 Advancements in Carotid Stenting with Dr. Adnan Siddiqui 31.03.2026 37min

  Clean lumen club! This week, BackTable meets you at the carotid bifurcation to discuss all things carotid angioplasty and stenting. Interventional neuroradiologist and cerebrovascular surgeon Dr. Adnan Siddiqui, Vice Chairman of the University of Buffalo’s Department of Neurosurgery, joins host Dr. Sameh Sayfo to discuss the evolution and current state of carotid disease treatment. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Terumohttps://www.terumois.com/ --- Timestamps 00:00 - Introduction02:48 - From Aspirin to Endarterectomy03:47 - Rise of Carotid Stenting06:46 - CREST-2 and CMS Coverage09:57 - Management of Severe Asymptomatic Carotid Stenosis 15:35 - New Stent Designs Explained17:56 - Five Tips for New Operators20:08 - Case Selection Algorithm22:04 - Learning Curve and Mentorship28:27 - What’s Next: IVL and Outpatient31:24 - Managing Complications Safely35:05 - Closing and Credits --- More about this episode Dr. Siddiqui details the history of carotid stenosis treatment, charting its path and progression from medical therapy to endarterectomy and modern stenting approaches. He includes how recent trial data and updated CMS reimbursements have influenced practice and generated recent developments such as second generation stent technology. Dr. Siddiqui shares perspectives on patient selection, operator learning curve, complication preparedness, and the importance of structured training and proctoring as technology and techniques continue to improve. The physicians close by overviewing future directions for the carotid space such as IVL and how to approach management of procedural complications. --- Resources Dr. Adnan Siddiqui provider profilehttps://www.ubns.com/physicians/dr-adnan-h-siddiqui/ Carotid Endarterectomy for Asymptomatic Carotid Stenosis: Asymptomatic Carotid Surgery Trial (ACAS)https://www.ahajournals.org/doi/10.1161/01.str.0000141706.50170.a7 Asymptomatic Carotid Surgery Trial (ACST-2)https://www.acc.org/latest-in-cardiology/clinical-trials/2021/08/25/23/24/acst2 Protected Carotid-Artery Stenting versus Endarterectomy in High-Risk Patients (SAPPHIRE trial)https://www.nejm.org/doi/full/10.1056/NEJMoa040127 Medical Management and Revascularization for Asymptomatic Carotid Stenosis (CREST-2 trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2508800 The North American Symptomatic Carotid Endarterectomy Trial (NASCET trial)https://www.ahajournals.org/doi/10.1161/01.str.30.9.1751
• Ep. 30 ECMO for Cardiologists: Practical Insights & Management with Dr. Allison Dupont 24.03.2026 59min

  Understanding when to use extracorporeal membrane oxygenation (and how) can be extra complex, but knowing the intricacies of ECMO is key to using it effectively. In this episode of BackTable Cardiology, Dr. Hady Lichaa sits down with Dr. Allison Dupont to approach ECMO in a practical, clinically relevant way. They cover the fundamentals, including VV versus VA ECMO, circuit components, and key settings like flow, oxygenation, and CO2 removal. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction03:19 - What Is ECMO12:19 - Who Should Get ECMO16:12 - ECPR Criteria and Triage29:45 - Access Strategy32:43 - Low Flow Troubleshooting44:24 - Anticoagulation Protocols48:21 - Chugging Volume Alarms50:25 - Weaning Off ECMO55:22 - Building An ECMO Program --- More about this episode The conversation also dives into real-world application, including cannulation strategies, typical flow parameters, troubleshooting low flow, preventing limb ischemia, and managing anticoagulation. They explore advanced topics like LAVA-ECMO for valvular disease, ECPR protocols inspired by the ARREST Trial, and how to think about patient selection and “bridge” strategies. Dr. DuPont finishes with practical insights on weaning, LV unloading, bleeding management, and what it takes to successfully build an ECMO program with a multidisciplinary team.---ResourcesDr. Hady Lichaa’s Provider Profilehttps://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaaDr. Allison Dupont’s Provider Profilehttps://northsidecvi.com/providers/our-cardiologists/allison-dupontAdvanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trialhttps://pubmed.ncbi.nlm.nih.gov/33197396/
• Ep. 29 Radial Access for Peripheral Interventions: Techniques & Considerations with Dr. Shailendra Singh 17.03.2026 1h 7min

  Radial roots, peripheral reach! Radial to peripheral (R2P) access is the focus of this week’s episode with interventional cardiologist Dr. Shailendra Singh (Pennsylvania’s Lehigh Valley Heart and Vascular Institute) and dual hosts Hady Lichaa and Sameh Sayfo. The conversation focuses on key techniques, pre-procedure planning and imaging, and ideal case selection for those new to the R2P approach. --- This podcast is supported by: Terumohttps://www.terumois.com/ --- SYNPOSIS Dr. Singh shares how he began incorporating radial-to-peripheral procedures into his practice after fellowship and how his experience with radial coronary access translated naturally to peripheral interventions. The group reviews access strategy, including right versus left radial selection, along with techniques for preventing and managing radial spasm. They also touch on staff workflow and training when introducing R2P into the lab. The episode closes with practical insights on case selection for operators new to the approach, the role of pedal access in selected CTO cases, and strategies for safe sheath removal and hemostasis. --- TIMESTAMPS 00:00 - Introduction04:42 - Radial-to-Peripheral: Right vs Left Radial10:18 - Ultrasound and Pedal Access Applications17:10 - Ideal Cases When Starting Radial to Peripheral25:59 - Impactful Radial Success Stories29:38 - Managing Radial Spasm 35:22 - Left Radial Workflow42:00 - Shelf Setup Essentials48:43 - Renal Mesenteric Access55:37 - Safe Sheath Removal01:01:10 - Training and Courses01:04:48 - Closing Thoughts --- RESOURCES Dr. Shailendra Singh’s Provider Profile https://www.lvhn.org/doctors/shailendra-singh Dr. Sameh Sayfo’s Provider Profilehttps://www.bswhealth.com/physician/sameh-sayf Dr. Hady Lichaa’s Provider Profilehttps://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa
• Ep. 28 Understanding Manual and Mechanical Coronary Thrombectomy in Practice with Dr. Andrew Goldsweig 10.03.2026 38min

  TAPAS, TASTE, TOTAL. These are the names of clinical trials that re-evaluated the use of manual aspiration thrombectomy in STEMI. In this episode of BackTable Cardiology, host Dr. Sameh Sayfo interviews Dr. Andrew Goldsweig, Director of Cardiovascular Clinical Research at Baystate Medical Center and Chair of the SCAI Standards and Guidelines Committee, about coronary thrombectomy in contemporary PCI. --- This podcast is supported by an educational grant from Cheisi. --- SYNPOSIS Drs. Sayfo and Goldsweig review how evidence from major trials led to a Class III recommendation against routine manual aspiration thrombectomy in STEMI, discuss methodological differences among studies and concerns about stroke reporting, and clarify how selective or bailout use may still have a role in high thrombus-burden cases. Their conversation also covers growing interest in mechanical thrombectomy technologies, the design and limitations of newer device studies, practical considerations that influence adoption, and differing operator approaches to STEMI workflows. They conclude by discussing gaps in evidence, the need for comparative data, and potential future features of next-generation coronary thrombectomy devices. --- TIMESTAMPS 00:00 - Introduction02:51 - Manual vs Mechanical Thrombectomy03:56 - TAPAS, TASTE, and TOTAL Trials10:20 - CHEETAH Trial Breakdown13:05 - Practice Patterns and Billing16:26 - Step by Step STEMI Workflow20:09 - Door to Balloon Reality22:03 - Impella First Strategy24:08 - High Thrombus Scenarios33:30 - Wishlist Catheter Features --- RESOURCES Dr. Sameh Sayfo’s Provider Profilehttps://www.bswhealth.com/physician/sameh-sayf Dr. Andrew Goldsweig’s Provider Profilehttps://www.baystatehealth.org/providers/andrew-m-goldsweig A Prospective, Multicentre, Long-Term Cohort Study in Children, Adolescents and Adults with Seasonal Allergic Rhinitis-Design and Early Results (TAPAS)https://pubmed.ncbi.nlm.nih.gov/40283440/ Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction (TASTE)https://www.nejm.org/doi/full/10.1056/NEJMoa1308789 Randomized Trial of Primary PCI with or without Routine Manual Thrombectomy (TOTAL)https://www.nejm.org/doi/full/10.1056/NEJMoa1415098 CHEETAH Study by Penumbrahttps://www.penumbrainc.com/cheetah-study-results/
• Ep. 27 Enhancing Cardiology Practice Through Radiation Protection with Dr. Bob Foster 03.03.2026 55min

  What do all image-guided interventionalists and surgeons have in common? Over time, the radiation exposure and the weight of lead begin to take a toll, often in ways no one talks about until it’s too late. In this episode of BackTable Cardiology, host Dr. Hady Lichaa sits down with Dr. Bob Foster, interventional cardiologist and Chief Medical Officer of Rampart IC, for a candid conversation about the hidden occupational risks facing today’s cath lab teams. --- SYNPOSIS Drawing on his extensive experience, he reflects on a career in complex coronary and peripheral intervention and the personal health crisis that forced him to confront the hidden dangers of operating in lead.National survey data from the Society for Cardiovascular Angiography and Interventions (SCAI) reveal a sobering trend in orthopedic injury rates, prompting a deeper look at why meaningful change has been so slow. From workflow realities and emerging clinical data to advocacy efforts, this episode explores what it will take to truly move the needle on operator safety. --- TIMESTAMPS 00:00 - Introduction01:03 - The Lack of Progression for Radiation Protection 06:37 - Rampart’s Origin Story14:24 - Evaluating the Data23:28 - Workflow & Setup Time: Lab Practicalities28:30 - Orthopedic Ergonomics33:06 - Beyond Cardiology: Other Interventional Surgery Specialties36:06 - Cost, ROI, and Legislation41:54 - Making Advanced Shielding Practical and Affordable50:46 - Protecting the Next Generation --- RESOURCES Dr. Hady Lichaa’s Provider Profilehttps://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa Dr. Bob Foster’s Provider Profilehttps://www.doximity.com/pub/robert-foster-md-5201e3aa Rampart IChttps://rampart.com
• Ep. 26 Renal Denervation: Innovations in Hypertension Management with Dr. Eric Secemsky 24.02.2026 49min

  John Doe is a 45 year-old male with a past medical history of hypertension, on high doses of amlodipine, metoprolol and lisinopril presenting to his cardiologist with a blood pressure of 165/86. He asks, “If the medications are not controlling my blood pressure, what are my options?” In this episode of the BackTable Cardiology Podcast, Dr. Sameh Sayfo sits down with Dr. Eric Secemsky, an internationally recognized interventional cardiologist and vascular medicine specialist to discuss renal denervation, a minimally invasive procedure that lowers blood pressure by disrupting overactive renal sympathetic nerves. --- SYNPOSIS From its proof of concept to the clinical trials that have shaped the current landscape, Drs. Sayfo and Secemsky dive into the intricacies of renal denervation. They explore the technical aspects of catheter-based denervation devices like Medtronic's Spyral catheter and Recor's Paradise device, discussing their procedures, safety features, and troubleshooting tips. The conversation also covers the significance of building advanced hypertension centers, the latest in renal denervation innovations, and the creation of a national registry to track procedural outcomes and enhance patient care. --- TIMESTAMPS 00:00 - Introduction02:52 - Guidelines Update: Why Renal Denervation Earned a Class 2B Recommendation07:31 - Clinical Trials: What Went Wrong, What We Learned, and How Devices Improved15:08 - Medtronic Symplicity Spyral22:17 - ReCor Paradise27:30 - Covering the Main Renal Artery: Anatomic Variants and Proximal Treatment Strategy33:15 - Beyond Kidneys: Multi-Organ Denervation and Metabolic Effects40:27 - Why Institutions Should Build Hypertension Centers --- RESOURCES Dr. Sameh Sayfo’s Provider Profilehttps://www.bswhealth.com/physician/sameh-sayf Dr. Eric Secemsky’s Provider Profilehttps://findadoc.bidmc.org/details/3519 A Controlled Trial of Renal Denervation for Resistant Hypertensionhttps://www.nejm.org/doi/full/10.1056/NEJMoa1402670 Medtronic Symplicity Spyral™ Renal Denervation Systemhttps://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/symplicity-spyral-renal-denervation-system.html SPYRAL GEMINI Pilot Studyhttps://clinicaltrials.gov/study/NCT06907147 Ablation of Arteries for the Treatment of Type 2 Diabetes Mellitus and Its Comorbidities (NECTAR IV) Trial https://clinicaltrials.gov/study/NCT05369065
• Ep. 25 IVL & Atherectomy: Techniques for Complex PCI with Dr. Yousif Ahmad 17.02.2026 1h

  How do imaging, intravascular lithotripsy, and equipment selection come together to effectively target coronary calcium? In this episode of BackTable, interventional cardiologists Dr. Robert Riley (Overlake Medical Center in Bellevue, Washington) and Dr. Yousif Ahmad (UCSF) trade techniques and discuss various aspects of calcium modification in complex percutaneous coronary intervention (PCI). --- This podcast is supported by: Shockwave Medicalhttps://shockwavemedical.com/ --- SYNPOSIS The discussion begins with an overview of intravascular lithotripsy (IVL), including its mechanism of action, ideal lesion characteristics, and performance across varying calcium morphologies. The conversation then expands to comparative decision-making among atherectomy, specialty balloons, and IVL, emphasizing how intravascular imaging informs procedural planning and real-time optimization. Key clinical data are reviewed, including the Disrupt CAD I-IV series as well as findings from the Short-Cut and VICTORY trials. The episode concludes with a forward-looking discussion on emerging technologies and the ongoing challenge of treating calcified nodules, one of the most demanding substrates in coronary intervention. --- TIMESTAMPS 00:00 - Introduction04:16 - Complex PCI and Calcium Modification Tools04:43 - Intravascular Lithotripsy (IVL) Insights and Evolution12:08 - Calcium Modification Algorithms and Techniques27:24 - IVUS vs. OCT Imaging and Specialty Balloons32:12 - Challenges in Implementing New Techniques37:09 - Influential Studies in Calcium Modification40:52 - Recent Studies: Short-Cut and VICTORY53:11 - Future of Calcium Modification Technologies57:48 - Final Thoughts --- RESOURCES Dr. Robert Rileyhttps://www.scai.org/robert-f-riley-md-ms-fscai Dr. Yousif Ahmadhttps://profiles.ucsf.edu/yousif.ahmad Intravascular imaging-guided coronary drug-eluting stent implantation: an updated network meta-analysishttps://pubmed.ncbi.nlm.nih.gov/38401549/ Coronary intravascular lithotripsy for severe coronary artery calcification: The Disrupt CAD I-IV trialshttps://www.sciencedirect.com/science/article/abs/pii/S1553838924000769 Orbital Atherectomy vs. Conventional Balloon Angioplasty in Severely Calcified Coronary Arteries Prior to DES Implantation - ECLIPSEhttps://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2024/10/25/04/32/eclipse Shockwave Lithoplasty Compared to Cutting Balloon Treatment in Calcified Coronary Disease - A Randomized Controlled Trial (Short-Cut)https://clinicaltrials.gov/study/NCT06089135 The Value of IVL Compared To OPN Non-Compliant Balloons for Treatment of RefractorY Coronary Lesions (VICTORY) Trial (VICTORY)https://clinicaltrials.gov/study/NCT05346068
• Ep. 24 Mitigating Orthopedic Strain and Radiation Effects: Best Practices in the Cath Lab with Dr. Sahil Parikh 10.02.2026 51min

  This is a friendly reminder to unclench your jaw, sit up straight, and take a deep breath before diving into the latest episode of BackTable Cardiology! Host Dr. Sameh Sayfo from Baylor Scott & White Health speaks with Dr. Sahil Parikh, a renowned interventional cardiologist from Columbia University, about the health of interventional cardiologists. They discuss the various occupational hazards interventional cardiologists may be at risk for, particularly focusing on radiation exposure and orthopedic injuries caused by wearing lead aprons. The conversation touches on the need for better education and mandatory training for upcoming cardiologists to prevent such injuries. --- SYNPOSIS As Dr. Parikh shares his personal experiences with orthopedic issues related to the extensive use of lead protection, he highlights the importance of radiation safety and advocates for incorporating advanced protective technologies in the labs. Dr. Sayfo and Dr. Parikh also discuss the significant trials presented at TCT 2025, their potential impact on clinical practice, and the importance of advocacy by societies like SCAI and the American College of Cardiology (ACC) in improving interventional cardiologists' working conditions. --- TIMESTAMPS 00:00 - Introduction01:58 - Orthopedic Issues in Interventional Cardiology04:00 - The Impact of Wearing Lead13:06 - Ergonomics and Risk Factors15:47 - Preventative Measures and Solutions23:22 - The Role of Medical Societies27:00 - Radiation Reduction Devices Overview30:57 - Barriers to Adopting Safety Technologies35:40 - Addressing Burnout in Interventional Cardiology42:06 - Highlights from TCT 2025 --- RESOURCES Dr. Sahil Parikh Provider Profile https://doctors.columbia.edu/us/ny/new-york/sahil-a-parikh-md-161-fort-washington-avenue Dr. Sameh Sayfo Provider Profile https://www.bswhealth.com/physician/sameh-sayfo Cardiovascular Research Foundation's Transcatheter Cardiovascular Therapeutics (CRF TCT) Conference 2025 - The Global Forum for Interventional Cardiology https://www.tctconference.com/ Society for Cardiovascular Angiography & Interventionshttps://www.scai.org/ American College of Cardiologyhttps://www.acc.org/
• Ep. 23 Understanding DEB in Coronary Interventions: Techniques & Outcomes with Dr. Mohammad Alkhalil and Dr. Abhishek Kumar 03.02.2026 44min

  Are drug-eluting balloons (DEBs) the best way to treat in-stent restenosis? In this episode of BackTable Cardiology, host and interventional cardiologist Dr. Sameh Sayfo takes a closer look at the evolving applications of coronary DEBs with two esteemed guests from the UK, Dr. Mohammad Alkhalil and Dr. Abhishek Kumar. --- SYNPOSIS This conversation covers the history and application of DEBs in treating in-stent restenosis (ISR) and small vessel disease, the differences between paclitaxel and limus-based drugs, the importance of lesion preparation and imaging, and the future potential of DEBs in coronary interventions. Dr. Kumar elaborates on the LOVE DEB study, which is investigating the use of DEBs in large de novo vessels, while Dr. Alkhalil shares his experiences and insights on adapting DEB technology in various clinical scenarios, including bifurcation lesions and acute myocardial infarction. The episode emphasizes the current role of DEB technology while cautioning against a reckless approach to its application. --- TIMESTAMPS 00:00 - Introduction02:34 - Historical Perspective and Key Studies on DCB06:30 - Mechanisms and Imaging in In-Stent Restenosis11:39 - Comparing Paclitaxel and Limus DCBs13:24 - Choosing the Right DCB: Factors and Preferences17:23 - DCB in Complex Cases: Bifurcations and Beyond24:01 - Challenges and Adoption of DCB in Europe27:38 - The Role of Imaging in DCB Procedures30:13 - Insights from the LOVE DEB Study38:59 - Future Directions in DCB Technology --- RESOURCES Dr. Sameh Sayfo Provider Profile https://www.bswhealth.com/physician/sameh-sayfo LOVE DEB Clinical Trialhttps://clinicaltrials.gov/study/NCT05915468 The European Bifurcation Club Left Main Coronary Stent Study: A Randomized Comparison of Stepwise Provisional vs. Systematic Dual Stenting Strategies (EBC MAIN)https://pubmed.ncbi.nlm.nih.gov/34002215/
• Ep. 22 The Role of Cangrelor in Modern Interventional Cardiology: Practice, Guidelines, & Data Review with Dr. Roxana Mehran 27.01.2026 39min

  Fast acting and reversible: IV cangrelor offers rapid on, rapid off P2Y12 platelet inhibition that sidesteps oral absorption delays. In this episode of the BackTable Cardiology Podcast, host Dr. Sameh Sayfo welcomes renowned interventional cardiologist Dr. Roxana Mehran, incoming President elect of the American College of Cardiology (ACC), to discuss the emerging role of cangrelor and its implications on current cardiology practice. --- This podcast is supported by an educational grant from Cheisi. --- SYNPOSIS Dr. Mehran and Dr. Sayfo cover the history and outcomes of the CHAMPION PHOENIX trial, cangrelor’s adoption and underutilization, and the nuances of transitioning high acuity patients between IV and PO antiplatelet therapies. Dr. Mehran also addresses the role of gender in cardiovascular health and the importance of inclusive representation in clinical studies. The episode concludes with Dr. Mehran sharing her initiatives to support women and minorities in cardiology, including her work as co-founder of Women As One. --- TIMESTAMPS 00:00 - Introduction to the BackTable Podcast01:57 - Understanding Cangrelor and Its Impact02:18 - CHAMPION PHOENIX Study Insights07:02 - Challenges and Misconceptions of Cangrelor in Cardiogenic Shock and STEMI14:41 - Antiplatelet Bridging to Surgery and Gender Differences in Treatment17:39 - The SMILE Study and Real-World Applications20:49 - Advancing Women in Cardiology29:22 - Future of Interventional Cardiology32:53 - Holistic Cardiac and Vascular Health36:01 - Conclusion and Final Thoughts --- RESOURCES Dr. Roxana Mehran:https://profiles.mountsinai.org/roxana-mehran Dr. Sameh Sayfo:https://www.bswhealth.com/physician/sameh-sayfo Effect of Platelet Inhibition with Cangrelor during PCI on Ischemic Events (CHAMPION PHOENIX Trial):https://www.nejm.org/doi/full/10.1056/NEJMoa1300815 Cangrelor versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition – CHAMPION Platform Clinical Trialhttps://www.clinicaltrials.gov/study/NCT00385138 Intravenous Platelet Blockade with Cangrelor during PCI (CHAMPION PCI):https://www.nejm.org/doi/full/10.1056/NEJMoa0908629 Meta-Analysis of the Role of Cangrelor for Patients Undergoing Percutaneous Coronary Interventionhttps://www.sciencedirect.com/science/article/abs/pii/S0002914919300426 Timing, indications and transition patterns associated with cangrelor use in patients undergoing PCIhttps://pubmed.ncbi.nlm.nih.gov/40813532/ Women As Onehttps://womenasone.org/about/
• Ep. 21 Current HFpEF Treatments: Clinical Pearls & Progress with Dr. Jessica Huston 20.01.2026 55min

  If your New Year’s resolution involves learning more about current practice guidelines and emerging research on Heart Failure with Preserved Ejection Fraction (HFpEF), you’re in the right place! In this episode of the BackTable Cardiology Podcast, host Dr. Hady Lichaa welcomes heart failure specialist Dr. Jessica Huston to provide a practical update on managing heart failure with preserved ejection fraction (HFpEF). --- SYNPOSIS Dr. Huston and Dr. Lichaa discuss the complexity of diagnosing HFpEF, differences between HFpEF and diastolic heart failure, phenotypes within HFpEF, and treatment strategies, including the use of aldosterone blockers, SGLT-2 inhibitors, and GLP-1 agonists. Dr. Huston emphasizes the importance of phenotyping patients for accurate diagnosis and treatment, and discusses the potential of future therapies and devices. Their conversation also covers the role of inflammation, metabolic syndrome, and the challenges faced in managing fluid balance and hypertension in HFpEF patients. --- TIMESTAMPS 00:00 - Introduction02:20 - Understanding HFpEF05:23 - Phenotypes and Treatment Approaches06:29 - Metabolic Syndrome and HFpEF09:17 - Emerging Treatments and Clinical Trials11:36 - Medication Strategies and Challenges24:51 - Diuretics and Their Limitations31:35 - Advanced Diuretic Strategies35:37 - Hemodynamic Measurements and Their Implications40:02 - Coronary Disease and HFpEF42:52 - Future Directions in Heart Failure Treatment45:45 - Device Therapies and Patient Management49:39 - Concluding Thoughts and Future Prospects --- RESOURCES Dr. Jessica Huston Provider Profilehttps://healthcare.ascension.org/find-care/provider/1073874616/jessica-huston Dr. Hady Lichaa Provider Profilehttps://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa The SUMMIT Trialhttps://pubmed.ncbi.nlm.nih.gov/39555826/ The TOPCAT Trialhttps://pubmed.ncbi.nlm.nih.gov/24716680/ The FINEARTS Trialhttps://pubmed.ncbi.nlm.nih.gov/39225278/ The CADENCE Trialhttps://www.clinicaltrials.gov/study/NCT04945460
• Ep. 20 System Innovations in Medical Practice with Dr. Mohamad Alkhouli 13.01.2026 34min

  Clinicians play a central role in shaping cardiovascular innovation, yet many lack a clear pathway to participate. In this episode of BackTable Cardiology, Dr. Sameh Sayfo speaks with Dr. Mohamad Alkhouli, cardiologist and Chair of Research and Innovation at the Mayo Clinic, about practical approaches for clinician involvement in healthcare innovation and strategies to address persistent gaps in cardiovascular care access. --- SYNPOSIS The discussion examines Dr. Alkhouli’s decision to pursue an MBA, the role of business and organizational training in medical leadership, and how system-level thinking informs innovation beyond device development. Broader themes include stakeholder alignment, organizational behavior, and emerging opportunities for non-device innovation within contemporary cardiovascular practice. --- TIMESTAMPS 00:00 - Introduction01:49 - The Value of an MBA for Physicians05:24 - Understanding Systems and Organizational Behavior07:31 - Navigating Innovation in MedTech13:15 - Bridging the Gap Between Physicians and Business19:44 - The Role of Professional Societies in Innovation25:32 - Future Trends in Interventional Cardiology29:58 - Global Perspectives on Innovation31:47 - Closing Remarks and Credits --- RESOURCES American College of Cardiologyhttps://www.acc.org/ Bolt Medical AcquisitionBoston Scientific Announces Agreement to Acquire Bolt Medical, Inc. Silk Road Medical AcquisitionBoston Scientific Closes Acquisition of Silk Road Medical, Inc. Dr. Mohamad Alkhouli’s Provider Profile https://www.mayoclinic.org/biographies/alkhouli-mohamad-m-d-m-b-a/bio-20465257 Dr. Sameh Sayfo’s Provider Profilehttps://www.bswhealth.com/physician/sameh-sayfo