Ep. 56 Interventional Techniques for Chronic Thromboembolic Pulmonary Hypertension with Dr. Riyaz Bashir
BackTable CardiologyShow Notes
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.
---
Get the BackTable apphttps://www.backtable.com/app
---
Timestamps
00:00 - Introduction02:48 - Procedural Setup and Vascular Access06:31 - Sheath in Sheath Technique11:20 - Guide Catheter Selection17:53 - Wire Selection and Balloon Undersizing22:12 - Crossing Chronic Total Occlusions27:25 - Pulmonary Collaterals and Flush Occlusions32:33 - Guide Extensions and Contrast Reduction36:38 - Distal Perfusion Pressure Targets41:26 - Pressure Wire Selection and Wire Management45:54 - Balloon Sizing and Reperfusion Pulmonary Edema54:04 - Hemoptysis and Gelatin Sponge Embolization1:02:32 - Closing Remarks
---
More about this episode
Dr. Bashir describes a technique he has simplified over ten years, built around a single principle that the goal of the procedure is perfusion rather than a better looking angiogram. He explains why early sessions use deliberately undersized balloons to restore flow safely, how these lesions behave like scar tissue, and why retrograde approaches are risky in fragile pulmonary vessels. The discussion covers practical strategies for keeping distal pressure low, managing hemoptysis with balloon tamponade and gelatin sponge embolization, and staging treatment over several sessions. The discussion closes with advice on mechanical circulatory support planning and the judgment, preparation, and teamwork that make high-risk BPA safe and effective.
---
Resources
Mizoguchi H, Ogawa A, Munemasa M, Mikouchi H, Ito H, Matsubara H. Refined Balloon Pulmonary Angioplasty for Inoperable Patients With Chronic Thromboembolic Pulmonary Hypertension. Circ Cardiovasc Interv. 2012https://doi.org/10.1161/CIRCINTERVENTIONS.112.971077 Auger WR, et al. Balloon Pulmonary Angioplasty for Treatment of Chronic Thromboembolic Pulmonary Hypertension: Statement From the BPA-CTEPH Alliance. JACC Cardiovasc Interv. 2026https://doi.org/10.1016/j.jcin.2026.02.033 Nasri A, Bashir R, Lakhter V. Management of Complications of Balloon Pulmonary Angioplasty. Card Electrophysiol Clin. 2025https://doi.org/10.1016/j.ccep.2024.12.015 Lang IM, et al. Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: Results of an International Multicenter Prospective Registry. J Am Coll Cardiol. 2025https://doi.org/10.1016/j.jacc.2025.04.021 Aggarwal V, et al. Status and Future Directions for Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Disease With and Without Pulmonary Hypertension. A Scientific Statement From the American Heart Association. Circulation. 2024https://doi.org/10.1161/CIR.0000000000001197 Inami T, et al. Pulmonary Edema Predictive Scoring Index (PEPSI), a New Index to Predict Risk of Reperfusion Pulmonary Edema and Improvement of Hemodynamics in Percutaneous Transluminal Pulmonary Angioplasty. JACC Cardiovasc Interv. 2013https://doi.org/10.1016/j.jcin.2013.03.009 BackTable Cardiology Episode 36. Understanding CTEPH, Diagnostic and Interventional Techniqueshttps://www.backtable.com/shows/cardiology/podcasts/36/understanding-cteph-diagnostic-interventional-techniques Dr. Riyaz Bashir, Mayo Clinic, Jacksonvillehttps://www.mayoclinic.org/biographies/bashir-riyaz-m-b-b-s-m-d/bio-20590757 Dr. Hady Lichaa, BackTable contributor pagehttps://backtable.com/shows/vi/contributors/dr-hady-lichaa Dr. Hady Lichaa, Ascension Saint Thomas Hearthttps://healthcare.ascension.org/doctors/133
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.
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.
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.