Show Notes
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
More from BackTable Cardiology
Drug-coated balloons and a head-to-head trial against lithotripsy have put cutting and scoring balloons back at the center of complex percutaneous coronary intervention (PCI). On this episode of BackTable Cardiology, Dr. Nyal Borges interviews Dr. Ziad Ali, director of the DeMatteis Cardiovascular Institute, for an in-depth look at the mechanics, selection, and technique behind cutting and scoring balloons in complex PCI. They cover how these devices create a controlled dissection in fibrolipidic plaque, why they only fracture calcium that sits right at the lumen, and how lesion type and imaging should guide the choice between a conventional balloon, a specialty balloon and intravascular lithotripsy.
What does it actually take to open a chronically occluded pulmonary artery without pushing the patient into reperfusion pulmonary edema? On this episode of BackTable Cardiology, Dr. Hady Lichaa interviews Dr. Riyaz Bashir, interventional cardiologist and vascular medicine specialist at Mayo Clinic in Jacksonville, about the real-world, table-side technique of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension (CTEPH). They walk through vascular access, telescoping sheath setup, right heart catheterization, pressure wire guidance, balloon sizing, and step-by-step planning for each lobe and lesion.
When your questions in cardiology go beyond the bedside and into healthcare innovation and transformation, is an executive MBA your next step? On this episode of BackTable Cardiology, Dr. Ankit Patel interviews Dr. Abdulla A. Damluji of the Cleveland Clinic about his journey from clinical cardiology to business school, and how an MBA empowered him to drive real change in healthcare. Dr. Damluji shares how business education gave him the tools to lead new programs, challenge the financial assumptions behind emerging technologies, and build a cardiovascular center focused on aging.
When a coronary lesion won’t open at conventional pressures, what can an ultra-high pressure balloon do differently? On this episode of BackTable Cardiology, host Dr. Hady Lichaa welcomes Dr. Deepak Kapoor, interventional cardiologist at the Medical College of Georgia at Augusta University, to discuss the science, safety, and real-world applications of ultra-high pressure (UHP) balloons in calcified coronary intervention. Dr. Kapoor walks through the evolution of balloon design, the main scenarios where UHP balloons are most useful, and the technical details that set these devices apart from standard non-compliant balloons and other calcium modification tools.
As new guidelines redefine risk stratification for pulmonary embolism (PE), emerging technologies are also changing what it means to achieve procedural success. On this episode of the BackTable Podcast, interventional radiologist Dr. Julie Bulman (BIDMC) and interventional cardiologist Dr. Jay Giri (Penn Medicine) join host Dr. Chris Beck to discuss the evolving frameworks and technologies redefining standards for catheter-directed treatment of intermediate- and high-risk PE. They discuss the role of multidisciplinary PERT teams, patient selection, the impact of new thrombectomy devices, and why autologous blood return is a growing consideration for procedural success.