
Ep. 44 Coronary Calcium Modification: Treating the Impossible with Dr. Kate Kearney
BackTable CardiologyShow Notes
When should you keep pushing and when should you walk away during a tough chronic total occlusion (CTO) case with heavy coronary calcification? On this episode of BackTable Cardiology, coronary CTO expert Dr. Kate Kearney from the University of Washington joins Dr. Hady Lichaa to define what makes a coronary PCI truly complex and to break down real-world strategies for managing ambiguous, heavily calcified lesions. The discussion emphasizes the uncertainty of achieving a good outcome and highlights the critical role of troubleshooting and dynamic decision-making in the cath lab.
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Sponsorhttps://shockwavemedical.com/
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Timestamps
00:00 - Introduction04:48 - Hard CTO Case Insights 08:43 - CTO vs IVL Safety And Predictability15:18 - Atherectomy Lesion Length for Atherectomy23:13 - Interpreting Calcium on Imaging 27:58 - D-Shaped Stents after Calcium Modification30:19 - Left Main Bifurcation Strategy35:31 - IVL Versus Atherectomy Sequencing39:49 - When To Stop A Case50:28 - Future Of IVL And Imaging53:47 - Conclusion
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More about this episode
Dr. Kearney shares practical strategies developed through real CTO case experience, including when to deploy dynamic stop-or-continue decision-making and how to leverage “phone a friend” safety rules for complex cases. She explains how intravascular lithotripsy (IVL) has made balloon-based calcium modification more predictable, improved stent results, and encouraged a multimodal approach, while early atherectomy still plays a role for deliverability and control. The discussion also covers imaging-driven criteria for intervention, D-shaped stent placement, and tailored planning for left main bifurcation or ostial circumflex lesions, highlighting the value of collaborative and evidence-based practice in advanced coronary intervention.
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Resources
Dr. Hady Lichaa Physician Profile:
https://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa Dr. Kate Kearny Physician Profile:https://www.uwmedicine.org/bios/kathleen-kearney
ECLIPSE trial:https://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 (Short-Cut Trial): https://clinicaltrials.gov/study/NCT06089135
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