Ep. 43 Advancements in Tibial Artery Stenting & Scaffolding with Dr. Sahil Parikh
BackTable CardiologyShow Notes
What is the emerging role of bioresorbable scaffolds in treating tibial artery disease, and how do they compare with traditional stenting and drug delivery approaches? In this episode of the BackTable Podcast, Dr. Sabeen Dhand interviews interventional cardiologist Dr. Sahil Parikh at Columbia to explore the evolution of tibial artery stenting, drug-eluting technology, and the latest evidence behind bioresorbable scaffolds. The discussion highlights patient selection, treatment algorithms, technical considerations, and the impact of drug delivery choices on patient outcomes.
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Abbott
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Timestamps
00:00 - Introduction04:00 - Bioengineering Origins08:29 - Paclitaxel vs. Limus 13:43 - When to Stent Tibials 16:14 - Stepwise Tibial Algorithm 18:46 - Stent Platforms and Costs 23:09 - Bifurcation Stenting Basics 26:35 - Fracture and Crush Risks 30:10 - Device Selection: Born for Tibials 33:27 - Materials and Drug Kinetics 36:57 - How to Deploy Safely 40:46 - Cost and Reimbursement Reality 43:21 - Market Growth and Competitors 48:02 - Paclitaxel Mortality Scare 51:13 - Final Takeaways and Access
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More about this episode
Dr. Parikh reviews the differences between paclitaxel and sirolimus or limus agents, the historical dominance of paclitaxel in peripheral devices, and why peripheral therapy has lagged behind coronary interventions. He outlines a practical tibial treatment algorithm emphasizing crossing (often with retrograde access), imaging to assess calcium, lesion preparation (including IVL, specialty balloons, and atherectomy when needed), proper sizing, and bailout stenting for recoil or dissection, and addresses the unique challenges of distal placement, bifurcations, and occasional fractures. The discussion covers the evolution and rationale, absorption timeline, and clinical data for bioresorbable scaffolds, as well as reimbursement, emerging alternatives, and the ongoing debate over paclitaxel safety. Dr. Parikh also shares his perspective on the future of drug delivery, the need for payer support, and strategies for ensuring the best patient care across diverse clinical settings.
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Resources
US Esprit™ BTK System Product Information (https://www.cardiovascular.abbott/us/en/hcp/products/peripheral-intervention/esprit-btk-resorbable-scaffold-system.html?utm_medium=podcast&utm_source=backtable&utm_campaign=us-endo-esprit-btk&utm_division=vas&utm_product=esprit-btk&utm_content=kol&utm_type=other)
US Esprit™ BTK System Important Safety Information (https://www.cardiovascular.abbott/us/en/hcp/products/peripheral-intervention/esprit-btk-resorbable-scaffold-system/important-safety-information.html)
Drug-Eluting Resorbable Scaffold versus Angioplasty for Infrapopliteal Artery Disease(https://pubmed.ncbi.nlm.nih.gov/37888915/)
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