What do all image-guided interventionalists and surgeons have in common? Over time, the radiation exposure and the weight of lead begin to take a toll, often in ways no one talks about until it’s too late. In this episode of BackTable Cardiology, host Dr. Hady Lichaa sits down with Dr. Bob Foster, interventional cardiologist and Chief Medical Officer of Rampart IC, for a candid conversation about the hidden occupational risks facing today’s cath lab teams.

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SYNPOSIS

Drawing on his extensive experience, he reflects on a career in complex coronary and peripheral intervention and the personal health crisis that forced him to confront the hidden dangers of operating in lead.
National survey data from the Society for Cardiovascular Angiography and Interventions (SCAI) reveal a sobering trend in orthopedic injury rates, prompting a deeper look at why meaningful change has been so slow. From workflow realities and emerging clinical data to advocacy efforts, this episode explores what it will take to truly move the needle on operator safety.

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TIMESTAMPS

00:00 - Introduction
01:03 - The Lack of Progression for Radiation Protection
06:37 - Rampart’s Origin Story
14:24 - Evaluating the Data
23:28 - Workflow & Setup Time: Lab Practicalities
28:30 - Orthopedic Ergonomics
33:06 - Beyond Cardiology: Other Interventional Surgery Specialties
36:06 - Cost, ROI, and Legislation
41:54 - Making Advanced Shielding Practical and Affordable
50:46 - Protecting the Next Generation

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RESOURCES

Dr. Hady Lichaa’s Provider Profile
https://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa

Dr. Bob Foster’s Provider Profile
https://www.doximity.com/pub/robert-foster-md-5201e3aa

Rampart IC
https://rampart.com

John Doe is a 45 year-old male with a past medical history of hypertension, on high doses of amlodipine, metoprolol and lisinopril presenting to his cardiologist with a blood pressure of 165/86. He asks, “If the medications are not controlling my blood pressure, what are my options?” In this episode of the BackTable Cardiology Podcast, Dr. Sameh Sayfo sits down with Dr. Eric Secemsky, an internationally recognized interventional cardiologist and vascular medicine specialist to discuss renal denervation, a minimally invasive procedure that lowers blood pressure by disrupting overactive renal sympathetic nerves.

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SYNPOSIS

From its proof of concept to the clinical trials that have shaped the current landscape, Drs. Sayfo and Secemsky dive into the intricacies of renal denervation. They explore the technical aspects of catheter-based denervation devices like Medtronic's Spyral catheter and Recor's Paradise device, discussing their procedures, safety features, and troubleshooting tips. The conversation also covers the significance of building advanced hypertension centers, the latest in renal denervation innovations, and the creation of a national registry to track procedural outcomes and enhance patient care.

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TIMESTAMPS

00:00 - Introduction
02:52 - Guidelines Update: Why Renal Denervation Earned a Class 2B Recommendation
07:31 - Clinical Trials: What Went Wrong, What We Learned, and How Devices Improved
15:08 - Medtronic Symplicity Spyral
22:17 - ReCor Paradise
27:30 - Covering the Main Renal Artery: Anatomic Variants and Proximal Treatment Strategy
33:15 - Beyond Kidneys: Multi-Organ Denervation and Metabolic Effects
40:27 - Why Institutions Should Build Hypertension Centers

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RESOURCES

Dr. Sameh Sayfo’s Provider Profile
https://www.bswhealth.com/physician/sameh-sayf

Dr. Eric Secemsky’s Provider Profile
https://findadoc.bidmc.org/details/3519

A Controlled Trial of Renal Denervation for Resistant Hypertension
https://www.nejm.org/doi/full/10.1056/NEJMoa1402670

Medtronic Symplicity Spyral™ Renal Denervation System
https://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/symplicity-spyral-renal-denervation-system.html

SPYRAL GEMINI Pilot Study
https://clinicaltrials.gov/study/NCT06907147

Ablation of Arteries for the Treatment of Type 2 Diabetes Mellitus and Its Comorbidities (NECTAR IV) Trial
https://clinicaltrials.gov/study/NCT05369065

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).

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This podcast is supported by:

Shockwave Medical
https://shockwavemedical.com/

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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.

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TIMESTAMPS

00:00 - Introduction
04:16 - Complex PCI and Calcium Modification Tools
04:43 - Intravascular Lithotripsy (IVL) Insights and Evolution
12:08 - Calcium Modification Algorithms and Techniques
27:24 - IVUS vs. OCT Imaging and Specialty Balloons
32:12 - Challenges in Implementing New Techniques
37:09 - Influential Studies in Calcium Modification
40:52 - Recent Studies: Short-Cut and VICTORY
53:11 - Future of Calcium Modification Technologies
57:48 - Final Thoughts

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RESOURCES

Dr. Robert Riley
https://www.scai.org/robert-f-riley-md-ms-fscai

Dr. Yousif Ahmad
https://profiles.ucsf.edu/yousif.ahmad

Intravascular imaging-guided coronary drug-eluting stent implantation: an updated network meta-analysis
https://pubmed.ncbi.nlm.nih.gov/38401549/

Coronary intravascular lithotripsy for severe coronary artery calcification: The Disrupt CAD I-IV trials
https://www.sciencedirect.com/science/article/abs/pii/S1553838924000769

Orbital Atherectomy vs. Conventional Balloon Angioplasty in Severely Calcified Coronary Arteries Prior to DES Implantation - ECLIPSE
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 - 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

This is a friendly reminder to unclench your jaw, sit up straight, and take a deep breath before diving into the latest episode of BackTable Cardiology! Host Dr. Sameh Sayfo from Baylor Scott & White Health speaks with Dr. Sahil Parikh, a renowned interventional cardiologist from Columbia University, about the health of interventional cardiologists. They discuss the various occupational hazards interventional cardiologists may be at risk for, particularly focusing on radiation exposure and orthopedic injuries caused by wearing lead aprons. The conversation touches on the need for better education and mandatory training for upcoming cardiologists to prevent such injuries.

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SYNPOSIS

As Dr. Parikh shares his personal experiences with orthopedic issues related to the extensive use of lead protection, he highlights the importance of radiation safety and advocates for incorporating advanced protective technologies in the labs. Dr. Sayfo and Dr. Parikh also discuss the significant trials presented at TCT 2025, their potential impact on clinical practice, and the importance of advocacy by societies like SCAI and the American College of Cardiology (ACC) in improving interventional cardiologists' working conditions.

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TIMESTAMPS

00:00 - Introduction
01:58 - Orthopedic Issues in Interventional Cardiology
04:00 - The Impact of Wearing Lead
13:06 - Ergonomics and Risk Factors
15:47 - Preventative Measures and Solutions
23:22 - The Role of Medical Societies
27:00 - Radiation Reduction Devices Overview
30:57 - Barriers to Adopting Safety Technologies
35:40 - Addressing Burnout in Interventional Cardiology
42:06 - Highlights from TCT 2025

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RESOURCES

Dr. Sahil Parikh Provider Profile
https://doctors.columbia.edu/us/ny/new-york/sahil-a-parikh-md-161-fort-washington-avenue

Dr. Sameh Sayfo Provider Profile
https://www.bswhealth.com/physician/sameh-sayfo

Cardiovascular Research Foundation's Transcatheter Cardiovascular Therapeutics (CRF TCT) Conference 2025 - The Global Forum for Interventional Cardiology
https://www.tctconference.com/

Society for Cardiovascular Angiography & Interventions
https://www.scai.org/

American College of Cardiology
https://www.acc.org/

Are drug-eluting balloons (DEBs) the best way to treat in-stent restenosis? In this episode of BackTable Cardiology, host and interventional cardiologist Dr. Sameh Sayfo takes a closer look at the evolving applications of coronary DEBs with two esteemed guests from the UK, Dr. Mohammad Alkhalil and Dr. Abhishek Kumar.

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SYNPOSIS

This conversation covers the history and application of DEBs in treating in-stent restenosis (ISR) and small vessel disease, the differences between paclitaxel and limus-based drugs, the importance of lesion preparation and imaging, and the future potential of DEBs in coronary interventions. Dr. Kumar elaborates on the LOVE DEB study, which is investigating the use of DEBs in large de novo vessels, while Dr. Alkhalil shares his experiences and insights on adapting DEB technology in various clinical scenarios, including bifurcation lesions and acute myocardial infarction. The episode emphasizes the current role of DEB technology while cautioning against a reckless approach to its application.

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TIMESTAMPS

00:00 - Introduction
02:34 - Historical Perspective and Key Studies on DCB
06:30 - Mechanisms and Imaging in In-Stent Restenosis
11:39 - Comparing Paclitaxel and Limus DCBs
13:24 - Choosing the Right DCB: Factors and Preferences
17:23 - DCB in Complex Cases: Bifurcations and Beyond
24:01 - Challenges and Adoption of DCB in Europe
27:38 - The Role of Imaging in DCB Procedures
30:13 - Insights from the LOVE DEB Study
38:59 - Future Directions in DCB Technology

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RESOURCES

Dr. Sameh Sayfo Provider Profile
https://www.bswhealth.com/physician/sameh-sayfo

LOVE DEB Clinical Trial
https://clinicaltrials.gov/study/NCT05915468

The European Bifurcation Club Left Main Coronary Stent Study: A Randomized Comparison of Stepwise Provisional vs. Systematic Dual Stenting Strategies (EBC MAIN)
https://pubmed.ncbi.nlm.nih.gov/34002215/

Fast acting and reversible: IV cangrelor offers rapid on, rapid off P2Y12 platelet inhibition that sidesteps oral absorption delays. In this episode of the BackTable Cardiology Podcast, host Dr. Sameh Sayfo welcomes renowned interventional cardiologist Dr. Roxana Mehran, incoming President elect of the American College of Cardiology (ACC), to discuss the emerging role of cangrelor and its implications on current cardiology practice.

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This podcast is supported by an educational grant from Cheisi.

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SYNPOSIS

Dr. Mehran and Dr. Sayfo cover the history and outcomes of the CHAMPION PHOENIX trial, cangrelor’s adoption and underutilization, and the nuances of transitioning high acuity patients between IV and PO antiplatelet therapies. Dr. Mehran also addresses the role of gender in cardiovascular health and the importance of inclusive representation in clinical studies. The episode concludes with Dr. Mehran sharing her initiatives to support women and minorities in cardiology, including her work as co-founder of Women As One.

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TIMESTAMPS

00:00 - Introduction to the BackTable Podcast
01:57 - Understanding Cangrelor and Its Impact
02:18 - CHAMPION PHOENIX Study Insights
07:02 - Challenges and Misconceptions of Cangrelor in Cardiogenic Shock and STEMI
14:41 - Antiplatelet Bridging to Surgery and Gender Differences in Treatment
17:39 - The SMILE Study and Real-World Applications
20:49 - Advancing Women in Cardiology
29:22 - Future of Interventional Cardiology
32:53 - Holistic Cardiac and Vascular Health
36:01 - Conclusion and Final Thoughts

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RESOURCES

Dr. Roxana Mehran:
https://profiles.mountsinai.org/roxana-mehran

Dr. Sameh Sayfo:
https://www.bswhealth.com/physician/sameh-sayfo

Effect of Platelet Inhibition with Cangrelor during PCI on Ischemic Events (CHAMPION PHOENIX Trial):
https://www.nejm.org/doi/full/10.1056/NEJMoa1300815

Cangrelor versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition – CHAMPION Platform Clinical Trial
https://www.clinicaltrials.gov/study/NCT00385138

Intravenous Platelet Blockade with Cangrelor during PCI (CHAMPION PCI):
https://www.nejm.org/doi/full/10.1056/NEJMoa0908629

Meta-Analysis of the Role of Cangrelor for Patients Undergoing Percutaneous Coronary Intervention
https://www.sciencedirect.com/science/article/abs/pii/S0002914919300426

Timing, indications and transition patterns associated with cangrelor use in patients undergoing PCI
https://pubmed.ncbi.nlm.nih.gov/40813532/

Women As One
https://womenasone.org/about/

If your New Year’s resolution involves learning more about current practice guidelines and emerging research on Heart Failure with Preserved Ejection Fraction (HFpEF), you’re in the right place! In this episode of the BackTable Cardiology Podcast, host Dr. Hady Lichaa welcomes heart failure specialist Dr. Jessica Huston to provide a practical update on managing heart failure with preserved ejection fraction (HFpEF).

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SYNPOSIS

Dr. Huston and Dr. Lichaa discuss the complexity of diagnosing HFpEF, differences between HFpEF and diastolic heart failure, phenotypes within HFpEF, and treatment strategies, including the use of aldosterone blockers, SGLT-2 inhibitors, and GLP-1 agonists. Dr. Huston emphasizes the importance of phenotyping patients for accurate diagnosis and treatment, and discusses the potential of future therapies and devices. Their conversation also covers the role of inflammation, metabolic syndrome, and the challenges faced in managing fluid balance and hypertension in HFpEF patients.

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TIMESTAMPS

00:00 - Introduction
02:20 - Understanding HFpEF
05:23 - Phenotypes and Treatment Approaches
06:29 - Metabolic Syndrome and HFpEF
09:17 - Emerging Treatments and Clinical Trials
11:36 - Medication Strategies and Challenges
24:51 - Diuretics and Their Limitations
31:35 - Advanced Diuretic Strategies
35:37 - Hemodynamic Measurements and Their Implications
40:02 - Coronary Disease and HFpEF
42:52 - Future Directions in Heart Failure Treatment
45:45 - Device Therapies and Patient Management
49:39 - Concluding Thoughts and Future Prospects

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RESOURCES

Dr. Jessica Huston Provider Profile
https://healthcare.ascension.org/find-care/provider/1073874616/jessica-huston

Dr. Hady Lichaa Provider Profile
https://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa

The SUMMIT Trial
https://pubmed.ncbi.nlm.nih.gov/39555826/

The TOPCAT Trial
https://pubmed.ncbi.nlm.nih.gov/24716680/

The FINEARTS Trial
https://pubmed.ncbi.nlm.nih.gov/39225278/

The CADENCE Trial
https://www.clinicaltrials.gov/study/NCT04945460

Clinicians play a central role in shaping cardiovascular innovation, yet many lack a clear pathway to participate. In this episode of BackTable Cardiology, Dr. Sameh Sayfo speaks with Dr. Mohamad Alkhouli, cardiologist and Chair of Research and Innovation at the Mayo Clinic, about practical approaches for clinician involvement in healthcare innovation and strategies to address persistent gaps in cardiovascular care access.

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SYNPOSIS

The discussion examines Dr. Alkhouli’s decision to pursue an MBA, the role of business and organizational training in medical leadership, and how system-level thinking informs innovation beyond device development. Broader themes include stakeholder alignment, organizational behavior, and emerging opportunities for non-device innovation within contemporary cardiovascular practice.

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TIMESTAMPS

00:00 - Introduction
01:49 - The Value of an MBA for Physicians
05:24 - Understanding Systems and Organizational Behavior
07:31 - Navigating Innovation in MedTech
13:15 - Bridging the Gap Between Physicians and Business
19:44 - The Role of Professional Societies in Innovation
25:32 - Future Trends in Interventional Cardiology
29:58 - Global Perspectives on Innovation
31:47 - Closing Remarks and Credits

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RESOURCES

American College of Cardiology
https://www.acc.org/

Bolt Medical Acquisition
Boston Scientific Announces Agreement to Acquire Bolt Medical, Inc.

Silk Road Medical Acquisition
Boston Scientific Closes Acquisition of Silk Road Medical, Inc.

Dr. Mohamad Alkhouli’s Provider Profile https://www.mayoclinic.org/biographies/alkhouli-mohamad-m-d-m-b-a/bio-20465257

Dr. Sameh Sayfo’s Provider Profile
https://www.bswhealth.com/physician/sameh-sayfo

Preventing problems before they aggregate, P2Y12 inhibitor style! In this episode of the BackTable Cardiology Podcast, interventional cardiologist from MedStar Washington Hospital Center joins host Dr. Hady Lichaa for practical insights and key takeaways on antiplatelet use in the setting of acute coronary syndrome (ACS).
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This podcast is supported by an educational grant from Cheisi.
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SYNPOSIS
Dr. Hashim talks through the use of intravenous antiplatelet therapies, specifically cangrelor, for managing acute coronary syndrome. Their discussion explores the pharmacokinetics, clinical advantages, and potential future applications of IV P2Y12 inhibitors. Dr. Hashim shares his wealth of experience in antiplatelet case studies and shares best practices when transitioning patients from IV to oral antiplatelet therapies. The conversation focuses on enhancing patient outcomes, minimizing complications, and lessons learned from different clinical scenarios.
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TIMESTAMPS
00:00 - Introduction
03:31 - Intravenous Antiplatelet Therapies Overview
06:01 - The Importance of IV P2Y12 Inhibitors
09:15 - Guidelines and Usage of GP IIb/IIIa Inhibitors
11:30 - Advantages of IV P2Y12 Inhibitors in Clinical Practice
14:32 - Practical Applications and Case Studies
24:42 - Cost Effectiveness, Hospital Administration, Financial Implications
28:20 - Contraindications and Practical Considerations
30:09 - Loading and Infusion Protocols
34:58 - Bridging for Surgery
39:48 - Anticoagulation and Heparin Goals
48:55 - Future of IV Antiplatelet Therapy
50:44 - Conclusion
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RESOURCES
Association of 2B3A inhibition with new antiplatelet regimens in the setting of acute coronary syndromes: a meta-analysis of randomized controlled trials
https://academic.oup.com/eurheartj/article-abstract/34/suppl_1/P4861/2862796
Effect of Platelet Inhibition with Cangrelor during PCI on Ischemic Events - CHAMPION PHOENIX
https://www.nejm.org/doi/full/10.1056/NEJMoa1300815
Morphine for treatment of cough in idiopathic pulmonary fibrosis (PACIFY COUGH): a prospective, multicentre, randomised, double-blind, placebo-controlled, two-way crossover trial
https://pubmed.ncbi.nlm.nih.gov/38237620/
Abstract 4370674: Cangrelor Versus Oral P2Y12 Inhibitors During PCI in Cardiogenic Shock and Cardiac Arrest: A Systematic Review and Meta-analysis
https://www.ahajournals.org/doi/10.1161/circ.152.suppl_3.4370674
Dr. Hayder Hashim
https://www.medstarhealth.org/doctors/hayder-hashim-md
Dr. Hady Lichaa
https://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa

From sternotomy to software, the booming field of robotic cardiac surgery is bringing new minimally invasive treatment approaches to well-traveled cardiology conditions. This week on the BackTable Cardiology Podcast, Dr. Amber Edwards, a distinguished cardiothoracic surgeon from Ascension St. Thomas in Nashville, shares her expertise in robotic cardiac surgery with host and Tennessee neighbor Dr. Hady Lichaa. The two physicians discuss the growth and technical advancements within robotic cardiac surgery, including the burgeoning field of hybrid revascularization.

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SYNPOSIS

Dr. Edwards outlines her journey in the cardiothoracic field, sharing her experiences with pioneers of minimally invasive and robotic cardiac surgeries. The discussion explores various procedures, including totally endoscopic coronary artery bypass (TECAB), minimally invasive direct coronary artery bypass (MIDCAB), and robotic LIMA to LAD bypass. Dr. Edwards also elaborates on robotic left atrial appendage ligations, robotic mitral and aortic valve surgeries, and conversion procedures for atrial fibrillation, highlighting their technical challenges, patient selection, and potential for broader adoption.

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TIMESTAMPS

00:00 - Introduction
03:33 - MIDCAB and TECAB Procedures
07:11 - Preoperative Testing and Considerations
09:09 - Challenges and Complexities in Robotic Surgery
17:20 - Hybrid Revascularization and Antiplatelet Therapy
26:02 - The Future and Adoption of Robotic Surgery
30:56 - Exploring Robotic Left Atrial Appendage Ligation
32:03 - The Convergent Procedure for AFib Patients
40:56 - Robotic Mitral Valve Surgery: Techniques and Benefits
47:11 - The Future of Robotic Cardiac Surgery
50:20 - Conclusion

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RESOURCES

Dr. Amber Edwards
https://healthcare.ascension.org/find-care/provider/1699031591/amber-edwards

Dr. Hady Lichaa
https://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa

REvascularization CHoices Among Under-Represented Groups Evaluation: The RECHARGE Trial - Women (RECHARGE:W)
https://clinicaltrials.gov/study/NCT06399692