Sham-controlled, randomized, and double-blind: the COSIRA II trial has the makings to make big waves in the management of refractory angina. This week’s episode features two interventionalists that are well-versed in coronary sinus reducers and the trials investigating them. Dr. Ziad Ali, from St. Francis Hospital and Heart Center in New York, and Dr. Jai Khatri, with Weill Cornell Medicine, join BackTable Cardiology to discuss the challenges and potential solutions in treating refractory angina in interventional cardiology.

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This podcast is supported by:

Shockwave Reducer
https://shockwavemedical.com/clinical-evidence/cosira-ii/

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SYNPOSIS

The doctors cover the current approaches to managing chronic angina before and after PCI, discuss how to differentiate ischemic heart disease from non-ischemic chest pain, and address the burdens faced by patients with complex atherosclerotic disease. A significant focus of the episode is on the role of the coronary sinus reducer, including procedure technique, risks, benefits, and its potential for treating both obstructive coronary artery disease and microvascular disease. The doctors also explore the logistics and challenges of enrolling patients in the COSIRA-II trial and speculate on the future impact of this device in clinical practice.

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TIMESTAMPS

00:00 - Introduction
01:42 - Understanding Refractory Angina
03:36 - Diagnostic Approaches
06:32 - Medical Therapy for Angina
10:29 - Complex Cases and Treatment Strategies
18:00 - Coronary Sinus Reducer
27:11 - Understanding the Risks and Learning Curve
28:06 - The COSIRA II Trial
30:27 - Tips for Patient Recruitment and Management
33:05 - Handling Treadmill Tests and Patient Communication
38:10 - Referral Patterns and Inter-Institutional Collaborations
45:38 - Future of Coronary Sinus Reducer
50:33 - Final Thoughts

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RESOURCES

Dr. Ziad Ali
https://ziadalimd.com/

Dr. Jai Khatri
https://doctors.nyp.org/jaikirshan-khatri-md/cardiology-weill-greenberg-center

COSIRA Trial
https://www.nejm.org/doi/full/10.1056/NEJMoa1402556

COSIRA II Trial
https://clinicaltrials.gov/study/NCT05102019

Tricuspid valve repair has seen booming growth in the interventional arena in the last five years, and the trajectory is only up from here. In this episode, interventional cardiologists Dr. Joe Walsh and Dr. Aiden Raney share their wealth of insights and experiences with the latest advancements in tricuspid interventions.

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SYNPOSIS

The conversation covers recent landmark trials, relevant tricuspid physiology, and hands-on experiences in the cath lab with specialty devices like TriClip and Evoque. The interventionalists discuss patient selection, including how to distinguish which patients are most likely to benefit from intervention and how to define procedural success. Dr. Walsh and Dr. Raney also highlight the educational opportunities provided by MurmurMD, a specialized social media platform for peer-to-peer learning for cardiologists and cardiac surgeons.

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TIMESTAMPS

00:00 - Introduction
01:29 - Tricuspid Valve Interventions: An Overview
03:55 - Understanding Tricuspid Regurgitation
10:29 - Therapeutic Options for the Tricuspid Valve
29:25 - Evaluating Success Rates and Patient Expectations
32:27 - Right Heart Catheterization
33:04 - Patient Selection Criteria
34:18 - Challenges with Tricuspid Valve Procedures
34:31 - Case Study: Evoke Device Size Variation
35:26 - Impact of Tricuspid Annulus Rigidity
37:57 - Complications and Management in Tricuspid Procedures
50:00 - Financial Considerations and Reimbursement
54:17 - Training and Educational Resources
59:49 - Conclusion and Final Thoughts

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RESOURCES

Dr. Aidan Raney
https://www.providence.org/doctors/interventional-cardiology/az/phoenix/aidan-raney-1962631101

Dr. Joe Walsh
https://www.saintalphonsus.org/provider/joe-walsh

Coapt Study
https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2018/09/21/20/12/COAPT

Triluminate Study:
https://www.nejm.org/doi/full/10.1056/NEJMoa2300525

Triscend Study:
https://www.nejm.org/doi/full/10.1056/NEJMoa2401918

Coronary drug-eluting balloon technology continues to evolve, but has its utilization been stunted by stenting? In this episode, Dr. Sameh Sayfo, an interventional cardiologist, hosts Dr. Ron Waksman, an internationally recognized cardiologist and scientist, to discuss advancements in coronary interventions and the age-old question of which coronary revascularization tools to use in which clinical scenarios.
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SYNPOSIS
Dr. Waksman shares his 30-year journey in the field, detailing the history and transition from traditional balloon angioplasty to drug-eluting stents, and now to drug-coated balloons. They explore the benefits and challenges of each technology, the significance of vessel preparation, and the latest trials, including the De Novo Trial led by Dr. Waksman. The conversation also touches on the importance of physician education and proper training in adopting new technologies. Additionally, Dr. Waksman provides insights into his approach to conducting interviews with notable public figures and hints at future discussions at the CRT annual meeting, potentially featuring President Biden.
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TIMESTAMPS
00:00 - Introduction
03:40 - The History of Drug-Eluting Stents
07:25 - Vessel Preparation To Ensure Good Balloon Angioplastic Technique
10:36 - Bioabsorbable Scaffolds
14:57 - The AGENT IDE Randomized Clinical Trial
20:16 - The Use of Paclitaxel Versus Sirolumus in Drug-Eluting Stents
29:40 - Cardiovascular Research Technologies (CRT) Annual Meeting
31:02 - Advice for Early Stage Colleagues
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RESOURCES
Dr. Sameh Sayfo:
https://www.bswhealth.com/physician/sameh-sayfo
Dr. Ron Waksman
https://www.medstarhealth.org/doctors/ron-waksman-md
De Novo Trial, Drug-Coated Balloon for De Novo Coronary Artery Disease: Journal of American College of Cardiology State-of-the-Art Review
https://pubmed.ncbi.nlm.nih.gov/32138967/
The AGENT IDE Randomized Clinical Trial, Paclitaxel-Coated Balloon vs Uncoated Balloon for Coronary In-Stent Restenosis: The AGENT IDE Randomized Clinical Trial
https://pubmed.ncbi.nlm.nih.gov/38460161/

PERT Consortium 2025 gives interventionalists the reins to tackle even the toughest saddle pulmonary embolisms. In this episode of the BackTable Podcast, host Dr. Aaron Fritts welcomes interventional radiologist Dr. Osman Ahmed and interventional cardiologist Dr. Jonathan Paul to discuss their experiences at the annual PERT Consortium in San Diego, and offer their perspectives on the latest developments in pulmonary embolism (PE) treatment.

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SYNPOSIS

The doctors delve into advancements and trials within the PE treatment space, including new devices and clinical studies that are set to shape the future of pulmonary embolism care. The conversation highlights the value of collaboration between interventional specialties, the safety and efficacy of various PE interventions, and the growing trend of using combined therapies. They also provide updates on their ongoing innovation with Flow Medical, describing their philosophy and motivation for developing a new device for PE treatment that incorporates real-time pulmonary artery pressures, mean systolic and diastolic pressures, and a potential for AI utilization in the future.

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TIMESTAMPS

00:00 - Introduction
01:23 - PERT Consortium Highlights
02:11 - Emerging Clinical Trials and Innovations
03:59 - Thrombectomy Devices and Market Trends
12:37 - Flow Medical: Origin and Updates
19:37 - Advanced Data Tracking in Cardiology
20:45 - Remote Monitoring and Mobile Integration
22:45 - Cardiologists’ Data-Driven Approach
23:10 - Upcoming Studies and Data Insights
24:10 - Interventional Radiology and Cardiology Collaboration
25:07 - Access to Care and Procedure Adoption
27:32 - Final Thoughts

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RESOURCES

Pulmonary Embolism Response Team (PERT) Consortium
https://pertconsortium.org/

Flow Medical
https://www.flowmedical.co/

PEERLESS RCT
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.072364

RESCUE-II
https://www.jacc.org/doi/10.1016/j.jacadv.2025.101789

PEERLESS II
https://www.jscai.org/article/S2772-9303(24)01053-6/fulltext

Pulmonary Embolism - Thrombus Removal With Catheter-Directed Therapy (PE-TRACT)
https://clinicaltrials.gov/study/NCT05591118

The HI-PEITHO Study
https://www.bostonscientific.com/en-EU/medical-specialties/vascular-surgery/venous-thromboembolism-portal/pulmonary-embolism/clinical-data/hi-peitho.html

PRAGUE-26
https://eurointervention.pcronline.com/article/design-and-rationale-of-prague-26-a-multicentre-randomised-trial-of-catheter-directed-thrombolysis-for-intermediate-high-risk-acute-pulmonary-embolism

Pulmonary Embolism - Thrombus Removal With Catheter-Directed Therapy (PE-TRACT)

https://clinicaltrials.gov/study/NCT05591118

Aaron Fritts, MD
https://www.backtable.com/shows/vi/contributors/dr-aaron-fritts

Osman Ahmed, MD
https://jointvascular.com/team/osman-ahmed-m-d-fcirse/

Jonathan Paul, MD
https://www.uchicagomedicine.org/find-a-physician/physician/jonathan-d-paul

Real intracardiac echo cases, real-time developments! In this episode of BackTable Cardiology, host Dr. Sameh Sayfo is joined by Dr. Karim Al-Azizi, a structural interventional cardiologist at Baylor Scott & White Heart Hospital Plano. Together, they explore the evolving role of intracardiac echocardiography (ICE) through three real cases of ICE use in structural heart interventions. Join as they walk through patient profiles, imaging strategies, and clinical outcomes from ICE-guided cases.

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SYNPOSIS

Dr. Al-Azizi shares his journey into the field of structural heart disease, highlighting the practical benefits and challenges of ICE and describing how it is transforming procedural guidance and patient outcomes. The episode concludes with a discussion on the Dallas PCI conference, emphasizing practical, hands-on learning for physicians.

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TIMESTAMPS

00:00 - Introduction

02:46 - Advancements in Structural Heart Procedures

05:38 - Intracardiac Echocardiography (ICE) Explained

09:27 - Practical Applications of ICE

13:53 - Learning and Training in ICE

17:22 - Comparing ICE Technologies

22:38 - Case Studies: ICE in Action

43:54 - Dallas PCI Conference and Closing Remarks

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RESOURCES

Dr. Karim Al-Azizi
https://www.bswhealth.com/physician/karim-al-azizi

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

Baylor Scott & White Heart Hospital Plano
https://www.bswhealth.com/the-heart-hospital/locations/plano

ICE Overview
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.031343

ICE Use in SVT and Afib
https://pmc.ncbi.nlm.nih.gov/articles/PMC11270097/

ICE Use in Left Atrial Appendage
https://pmc.ncbi.nlm.nih.gov/articles/PMC12209866/

What coronary device do you reach for when a blockage won’t budge? In this episode of the BackTable Cardiology Podcast, Dr. Wissam Jaber from Emory University Hospital joins host Dr. Hady Lichaa to discuss the intricacies of coronary atherectomy, outlining the differences between rotational and orbital atherectomy, their indications, and their technical nuances.
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SYNPOSIS
Dr. Jaber shares his experiences with both rotational and orbital atherectomy, when he uses which for specific lesion subsets, potential complications, and strategies to manage them. This episode provides essential insights for cardiologists seeking to enhance their proficiency in managing calcified coronary lesions.
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TIMESTAMPS
00:00 - Introduction
04:39 - Use of Lasers in Atherectomy
07:12 - Determining Guide and Catheter Size
14:24 - Laser Contrast Mix
17:15 - Perforation Detection and Management
25:16 - Treating the Circumflex Ostium
32:17 - Using a Guide Extension Catheter with Atherectomy Devices
36:36 - Orbital Versus Rotational Atherectomy
47:21 - Navigating Tortuosity in Atherectomies
52:45 - Complications (Perforations, Dissections and Distal Embolizations)
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RESOURCES
Dr. Wissam Jaber
https://providers.emoryhealthcare.org/provider/wissam-a-jaber/777074
Dr. Hady Lichaa
https://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa

Ballin’ on a contrast budget! In this episode of BackTable Cardiology, Dr. Evan Shlofmitz outlines how utilizing imaging and physiology get you the most bang for your buck when performing low contrast PCI for patients with renal impairment.
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SYNPOSIS
Dr. Shlofmitz, co-director of Optimize PCI (OPCI) and a leading expert in intravascular imaging and physiology from St. Francis Hospital, New York, joins Dr. Sameh Sayfo, interventional cardiologist from Baylor Scott & White The Heart Hospital. Together, they delve into the importance of low contrast PCI, strategies to prevent contrast-induced nephropathy, and the use of advanced imaging techniques to aid in low contrast procedures that are critical for patients with renal impairment.
Dr. Shlofmitz shares insights into staging interventions, optimal use of contrast, and the integration of technologies like dynamic coronary roadmap and angiography-derived physiology. They also discuss the vital role of multidisciplinary collaboration, physician education, and industry support in enhancing patient outcomes by advocating for technology advancements in the cath lab. Dr. Shlofmitz highlights the Optimize PCI (OPCI) conference, which continues to advance the interventional cardiology field by providing hands-on workshops and regional courses in percutaneous cardiac procedures, imaging, access techniques, and much more.
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TIMESTAMPS
00:00 - Introduction to Guests
02:11 - Impaired Renal Function and Contrast Induced Nephropathy
06:55 - Contrast, GFR, and Hydration Status: Cath Lab Strategies for CKD
12:24 - NCDR and Quality Metrics for CIN
15:28 - Multidisciplinary Care: Bringing Nephrology on Board
18:26 - Staging Diagnostic and Intervention Procedures to Reduce Contrast
20:39 - Ultra Low Contrast Diagnostic Angiogram Technique
25:28 - Moderate Lesions in Ultra Low Contrast
29:36 - Technology: iFR Co-registration and Diagnostic Coronary Roadmap
40:15 - Physician Champions: Advocates for Implementing New Imaging
46:33 - Optimizing PCI (OPCI) Conference
50:40 - Conclusion
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RESOURCES
Evan Shlofmitz Provider Profile
https://doctors.catholichealthli.org/provider/evan-scott-shlofmitz/2405486
Intravascular Lithotripsy for Treatment of Severely Calcified Coronary Lesions: 1-Year Results From the Disrupt CAD III Study
https://www.jscai.org/article/S2772-9303(21)00001-6/fulltext
Sameh Sayfo Provider Profile
https://www.bswhealth.com/physician/sameh-sayfo
Statewide Initiative to Increase Intracoronary Imaging Optimization in PCI: A Report From the BMC2 Registry
https://www.jscai.org/article/S2772-9303(25)01152-4/fulltext
Optimize PCI (OPCI) - November Hands-On Workship
https://opci.live/event/opci-michigan-2025/
Optimize PCI (OPCI)
https://opci.live/

Reporting from inside the cath lab: advanced PCI techniques, cutting-edge imaging, and the future of interventional cardiology! In this episode of the BackTable Cardiology Podcast, Dr. Sameh Sayfo hosts Dr. Mirvat Alasnag, the director of research at the Cardiac Catheterization Lab at King Fahd Armed Forces Hospital in Saudi Arabia to discuss various coronary bifurcation intervention strategies, including TAP, DK Crush, and their indications.
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SYNPOSIS
The conversation delves into the use of drug-coated balloons (DCB), intracoronary imaging techniques like IVUS and OCT, and the importance of personalized patient care in high-risk percutaneous coronary interventions (PCIs). Additionally, Dr. Alasnag addresses the challenges and innovations in supporting women in interventional cardiology and the value of mentorship and career shadowing programs for aspiring cardiologists.
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TIMESTAMPS
00:00 - Introduction
02:06 - Understanding Bifurcation Coronary Intervention
04:00 - Strategies for Bifurcation Stenting
09:55 - The Role of Drug-Coated Balloons
13:08 - Importance of Intra-Coronary Imaging
16:31 - Global Perspectives on Bifurcation Interventions
27:57 - Advocacy for Women in Interventional Cardiology
31:42 - Mentorship and Career Guidance
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RESOURCES
Dr. Mirvat Alasnag:
https://www.radcliffecardiology.com/authors/mirvat-alasnag?language_content_entity=en
https://esc365.escardio.org/person/367232
Dr. Sameh Sayfo:
https://www.bswhealth.com/physician/sameh-sayfo
King Fahad Armed Forces Hospital:
https://www.linkedin.com/company/king-fahad-armed-forces-hospital/?trk=public_profile_topcard_past_company&originalSubdomain=ie
New Innovations at King Fahad Armed Forces Hospital (Jeddah)
https://elixirmedical.com/king-fahad-armed-forces-hospital-begins-trial-of-new-bioadaptive-angioplasty-procedure-for-heart-disease-treatment/
Fundamentals of percutaneous coronary bifurcation interventions:
https://pmc.ncbi.nlm.nih.gov/articles/PMC8968454/
Bifurcation stenting: current strategies and new devices
https://heart.bmj.com/content/95/6/495.short

It’s no shock that percutaneous ventricular assist devices (pVADs) play an important role in improving cardiogenic shock outcomes (pun intended). In this episode of the BackTable Cardiology Podcast, host Dr. Sameh Sayfo interviews Dr. Babar Basir, a renowned interventional cardiologist from Michigan, about advancements and protocols in managing cardiogenic shock.

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SYNPOSIS

Dr. Babar Basir details the history and development of the cardiogenic shock program initiated at Henry Ford Hospital, its national expansion, and its impact on patient outcomes. The conversation touches on the role of advanced heart failure specialists, ongoing trials like the Door to Unload trial, and the importance of small bore mechanical circulatory support devices. Dr. Babar Basir also highlights the significance of team-based approaches and the necessity of multidisciplinary care in improving survival rates for patients suffering from cardiogenic shock.

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TIMESTAMPS

00:00 - Introduction
03:50 - Impella in Shock: From Last-Resort to Early Use
07:30 - National Cardiogenic Shock Initiative
14:30 - Heart Failure Readmissions
17:46 - Additional Indications for Use of Impella Device
24:10 - Future Devices and Technological Advancements in the Field
27:03 - International Advancements in Shock Initiative Protocols
30:28 - Using Impella CP vs Impella 5.5
38:20 - SCAI Shock Conference and Importance of Attending

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RESOURCES

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

Dr. Babar Basir:
https://www.henryford.com/physician-directory/b/basir-mir

National Cardiogenic Shock Initiative
https://www.henryford.com/cardiogenicshock

Unloading the Left Ventricle Before Reperfusion in Patients With Anterior ST-Segment-Elevation Myocardial Infarction (also known as “Door to Unload Trial”):
https://pubmed.ncbi.nlm.nih.gov/30586728/

Upcoming SCAI Shock Conference September 18th-20th, 2025
https://scai.org/education-and-events/events-schedule/2025-scai-shock-0

Calcium belongs in the bones, not the blood vessels! But once it’s there, how can interventional cardiologists use their skills and tools to combat it? In this episode of the BackTable Cardiology Podcast, host Dr. Hady Lichaa interviews Dr. Yader Sandoval from the Minneapolis Heart Institute about handling coronary calcification.

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SYNPOSIS

Dr. Sandoval shares insights into the challenges of treating calcified coronary lesions, the importance of intravascular imaging, and his strategic approach to using technologies like intravascular lithotripsy, atherectomy, and specialty balloons. He emphasizes practical tips and tricks for interventional cardiologists to optimize procedure outcomes and tackle severe coronary calcification effectively. Their discussion overviews the latest innovations in the field, providing valuable advice for balancing advanced techniques with procedural efficiency.

Dr. Sandoval also details the where, when, and how of approaching in-stent restenosis (ISR), including how to use imaging to optimize treating heavy calcifications around stents.

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TIMESTAMPS

00:00 - Introduction
01:57 - Overview of Coronary Calcification
08:08 - Severe Calcification Cases: Equipment and Technique
21:08 - Guide Wires, Microcatheters, and Guide Extensions for Calcified Lesions
31:24 - IVUS vs OCT
36:21 - Atherectomy vs IVL Considerations
43:32 - Calcified Nodules
51:06 - Stents and In-Stent Restenosis Management
56:42 - Conclusion

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RESOURCES

Dr. Yader Sandoval
https://mplsheart.org/yader-sandoval-md
Abbott Northwestern Hospital

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

SCAI Expert Consensus Statement on Management of In-Stent Restenosis and Stent Thrombosis
https://pmc.ncbi.nlm.nih.gov/articles/PMC11308135/