
Ep. 52 Advanced Techniques in Retroflex Circumflex Lesions with Dr. Sripal Bangalore
BackTable CardiologyShow Notes
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.
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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
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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.
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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
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