BackTable Vascular & Interventional

In this episode of the BackTable Podcast, host Dr. Sabeen Dhand interviews Dr. Eric Secemsky about the efficacy of drug eluting technologies in vascular interventions, with Dr. Secemsky offering insight into his own practice. Dr. Secemsky is an interventional cardiologist practicing at Beth Israel Deaconess Medical Center in Boston.

Dr. Secemsky believes that drug coated technology is a game-changer in the endovascular space since it improves patient outcomes by reducing the risk of needing additional procedures. Dr. Secemsky highlights the importance of various trials such as IMPERIAL and EMINENT, which compare the effectiveness of different stents. He also speaks about the significance of the Cook Medical prediction model to calculate intervention success rates and the role of disease site-specific interventions. Dr. Secemsky ends the podcast by sharing his thoughts about advancements in the near future, including the use of bioabsorbable stents and sirolimus drug-coated balloons.

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CHECK OUT OUR SPONSOR

Cook Medical Zilver PTX

https://www.cookmedical.com/zilverptxbacktable

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SHOW NOTES

00:00 - Introduction

09:31 - Understanding Drug Coated Balloons and Stents

14:29 - The Paclitaxel Controversy

19:30 - Stenting Algorithm for Fem-Pop Disease

23:55 - Impact of Lithotripsy on Drug Delivery

26:02 - Predictability Models for Revascularization

29:14 - Economic Considerations in Drug Eluting Stent Usage

31:33 - Highlighting Trials on Drug Coated Technology and Drug Eluting Stents

37:08 - Future Technologies: Drug on Stent Grafts and Spot Stenting

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RESOURCES

Zilver PTX Cook Prediction Model:

https://cooksfa.z13.web.core.windows.net/

Risk of Death Following Application of Paclitaxel‐Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials:

https://www.ahajournals.org/doi/full/10.1161/JAHA.118.011245

Durable Clinical Effectiveness With Paclitaxel-Eluting Stents in the Femoropopliteal Artery: 5-Year Results of the Zilver PTX Randomized Trial:

https://pubmed.ncbi.nlm.nih.gov/26969758/

Mortality in randomized controlled trials using paclitaxel-coated devices for femoropopliteal interventional procedures: an updated patient-level meta-analysis:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02189-X/fulltext

Outcomes of Stented vs Nonstented Femoropopliteal Lesions Treated With Drug-Coated Balloon Angioplasty:

https://pubmed.ncbi.nlm.nih.gov/35179065/

Drug coated balloon improves outcomes of sub-optimal Supera deployment in the intermediate term:

https://pubmed.ncbi.nlm.nih.gov/36494491/

Directional Atherectomy Followed by a Paclitaxel-Coated Balloon to Inhibit Restenosis and Maintain Vessel Patency: Twelve-Month Results of the DEFINITIVE AR Study:

https://pubmed.ncbi.nlm.nih.gov/28916599/

Intravascular Lithotripsy for Peripheral Artery Calcification: 30-Day Outcomes From the Randomized Disrupt PAD III Trial:

https://pubmed.ncbi.nlm.nih.gov/34167675/

Efficacy of a Drug-Eluting Stent Versus Bare Metal Stents for Symptomatic Femoropopliteal Peripheral Artery Disease: Primary Results of the EMINENT Randomized Trial:

https://pubmed.ncbi.nlm.nih.gov/36254728/

A polymer-coated, paclitaxel-eluting stent (Eluvia) versus a polymer-free, paclitaxel-coated stent (Zilver PTX) for endovascular femoropopliteal intervention (IMPERIAL): a randomized, non-inferiority trial:

https://doi.org/10.1016/S0140-6736(18)32262-1

SPORTS Clinical Trial Results Boston Scientific:

https://www.bostonscientific.com/en-EU/medical-specialties/vascular-surgery/drug-eluting-stent-drug-coated-balloon/eluvia/sports-rct.html

In this episode of the Back Table Innovation Podcast, host Dr. Diana Velazquez-Pimentel, a radiologist and biomedical engineer, chats with Dr. Alim Mitha about the novel idea of biodegradable flow diverters and the future of interventional neuroradiology. Dr. Mitha is a cerebrovascular, endovascular, and skull base neurosurgeon and biomedical engineer at the University of Calgary.

During his neurosurgery residency, Dr. Mitha also completed a master’s degree in biomedical engineering. Afterwards, he pursued additional fellowships in cerebrovascular and skull base surgery, as well as endovascular neurosurgery. Since then, he has started a research lab focused on tissue engineering and biomedical device development. He explains the role of flow diverters and how they are used to guide blood flow away from the intracranial aneurysms.

While flow diverters have been applied to treatment of many different types of aneurysms, Dr. Mitha notes that these devices carry thrombogenic risks. During his training, he saw that it was not preferable to deploy a flow diverter in a young patient who would have to remain on antiplatelet therapy for the rest of their life. As a result, Dr. Mitha began to develop a polymer-based biodegradable flow diverter that could be absorbed by the body after the aneurysm had been occluded, in addition to being visible on non-invasive imaging. He explains the process of building a prototype, incorporating a company, joining a start-up incubator, and now performing first in-human-clinical trials.

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CHECK OUT OUR SPONSOR

RADPAD® Radiation Protection

https://www.radpad.com/

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SHOW NOTES

00:00 Introduction

03:05 Understanding the Role of Flow Diverters

08:17 The Conception of a Biodegradable Flow Diverter

11:35 The Challenges and Successes in Prototyping

13:53 A Path Towards Commercialization

16:10 Considerations for Clinical Adoption

24:00 Developing Skills for Engineering and Entrepreneurship

27:29 First-In-Human Trials and Early Feedback

30:36 Innovating Within the University of Calgary

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RESOURCES

University of Calgary Creative Destruction Lab:

https://creativedestructionlab.com/locations/calgary/

The Brain Conferences:

https://www.fens.org/meetings/the-brain-conferences

In this episode of the BackTable Podcast, host Dr. Ally Baheti interviews Dr. Michael Cumming about the issue of site of service differentials in healthcare. Dr. Cumming is an interventional radiologist and the founder of Vascular and Interventional Experts.

They discuss the history and the impact of these differentials, which often result in higher costs for identical services depending on the site they’re carried out in. For example, services offered within hospitals typically cost significantly more than those offered in ambulatory surgery centers or physician offices. The doctors also describe the role of key stakeholders such as lobbyists and industry players, the outcomes of care provided in various settings, and ongoing legislative efforts to address these issues. Finally, they discuss how physicians can advocate for high quality, value-based care.

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CHECK OUT OUR SPONSORS

Siemens Healthineers

https://www.siemens-healthineers.com/

Varian, a Siemens Healthineers company

https://www.varian.com/products/interventional-solutions/embolization-solutions

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SHOW NOTES

00:00 - Introduction

03:33 - Site of Service and Its Impact on Payment

06:15 - Role of CMS in Determining Payment

09:09 - Role of Advocacy Groups in Site of Service Payments

17:51 - Future of Site of Service Payments

20:17 - Negative Consequences of Site of Service Differentials

24:01 - Closing Remarks and Reflections

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RESOURCES

CMS.gov website:

https://www.cms.gov/

Preliminary Results of the Outpatient Endovascular and Interventional Society National Registry:

https://journals.sagepub.com/doi/10.1177/1526602820949970

In this episode of the BackTable podcast, host Dr. Ally Baheti interviews interventional radiologist Dr. Merve Ozen about the potential of the Percunav system, an advanced needle guidance technology used in interventional and endovascular procedures. Dr. Ozen is an Assistant Professor of Radiology, Surgery, Obstetrics, and Gynecology at the University of Kentucky.

The uniqueness of the Percunav system lies in its 3D ultrasound image fusion and navigation capabilities, which enable doctors to combine the advantages of different imaging techniques including CT, MR, PET, and ultrasound. This allows for more precise and accurate procedures, while reducing radiation exposure. However, the utilization of this technology requires understanding and overcoming the learning curve. Additionally, Dr. Ozen explores the various applications of this technology including biopsies, drain placements and other challenging interventions.

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SHOW NOTES

00:00 - Introduction

02:42 - Clinical Applications of 3D Fusion and Navigation Systems

11:43 - Limitations and Challenges of the Technology

17:30 - Exploring Different Needle Tracking Technologies

18:44 - Future Applications of the Technology

20:17 - Advice for Incorporating the Technology into Practice

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RESOURCES

Percunav System:

https://www.usa.philips.com/healthcare/product/HCNOCTN150/fusion-and-navigation-image-fusion-and-needle-navigation

In this episode, guest-host Dr. Paul Bhogal invites Dr. Adnan Qureshi, an interventional neurologist at the University of Missouri, to share his insights on innovative treatments for migraines.

Dr. Qureshi covers his pioneering work in intra-arterial lidocaine injections and their effect on patients with severe migraines. Injections have shown a significant relief in symptoms immediately following treatment. He emphasizes the importance of identifying the right patient group for such treatments and highlights the potential of interventions beyond standard drug therapy. The conversation also explores the role of interventional neuroradiology in treating migraines and the potential development of new medical devices and alternatives to lidocaine. The podcast ends with Dr. Qureshi endorsing the upcoming Brain Conference and encouraging participation.

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CHECK OUT OUR SPONSOR

RADPAD® Radiation Protection

https://www.radpad.com/

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SHOW NOTES

00:00 - Introduction and Overview of Migraine Treatment

05:35 - Initial Experiments with Lidocaine Treatment

17:45 - Potential for New Migraine Treatments

18:23 - Procedure for Intra Arterial Injections of Lidocaine

36:41 - Potential for Other Treatments and Future Research

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RESOURCES

BRAIN Conference London December 2024

Use code ‘BACKTABLE10’ to register:

https://www.millbrook-events.co.uk/event/a68ab951-6a92-4a9a-88ca-3e8dad79d971/summary

Dr. Qureshi’s Email Address:

[email protected]

Intra-arterial injection of lidocaine into middle meningeal artery to treat intractable headaches and severe migraine:

https://pubmed.ncbi.nlm.nih.gov/34388298/

MIDAS Score:

https://headaches.org/wp-content/uploads/2018/02/MIDAS.pdf

Chronic headaches and middle meningeal artery embolization:

https://pubmed.ncbi.nlm.nih.gov/33888570/

Intra-arterial lidocaine therapy via the middle meningeal artery for migraine headache: Theory, current practice and future directions:

https://pubmed.ncbi.nlm.nih.gov/37574789/

Dr. Nathan Manning ResearchGate Profile:

https://www.researchgate.net/profile/Nathan-Manning-4

In this episode, Dr. Tyler Sandow (Ochsner Health) interviews interventional radiologists Dr. Edward Kim (Mount Sinai) and Dr. Terence Gade (University of Pennsylvania) about the future directions of hepatocellular carcinoma (HCC) treatments, specifically focusing on the adoption of precision medicine and multidisciplinary approaches.

They delve into various HCC treatments, such as locoregional therapies like transarterial chemoembolization (TACE) and transarterial radioembolization (TARE), as well as the roles of systemic immunotherapies and checkpoint inhibitors. They highlight the importance of sequential order and timing of treatments and the use of imaging biomarkers for individualized cancer care.

Throughout the discussion, influential clinical trials in HCC treatment are discussed and summarized. The doctors unanimously agree that as the sphere of interventional oncology is rapidly evolving, the focus should be centered on providing the most effective and patient-specific care with a deep understanding of combination therapies.

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AstraZeneca

https://www.astrazeneca-us.com/

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SHOW NOTES

00:00 - Introduction

05:45 - The Beginnings of Systemic Therapy for HCC

08:28 - The Role of Immunotherapy in HCC Treatment

11:09 - Multidisciplinary Clinics and Tumor Boards

20:21 - The Society of Interventional Oncology and Treatment Guidelines

24.59 - Choosing Between Locoregional and Combination Therapies

39:17 - The Use of Immunotherapy in Early Stage Patients

42:08 - Current Safety Data for Immunotherapy

48.56 - TACE Drug Choice

53:16 - How to Approach Treatment of Multifocal or Large Tumors

01:00 - Timeline for Imaging to Assess Treatment Response

01:03 - The Future of Immunotherapy and Interventional Oncology

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RESOURCES

Society of Interventional Oncology (SIO):

https://www.sio-central.org/

Sorafenib in Advanced Hepatocellular Carcinoma (SHARP Trial)

https://www.nejm.org/doi/full/10.1056/nejmoa0708857

Efficacy and Safety of Sorafenib in Patients in the Asia-Pacific region with Advanced Hepatocellular Carcinoma:

https://pubmed.ncbi.nlm.nih.gov/19095497/

Efficacy and Safety of Nivolumab Plus Ipilimumab in Patients With Advanced Hepatocellular Carcinoma Previously Treated With Sorafenib (CheckMate 040 Trial):

https://jamanetwork.com/journals/jamaoncology/fullarticle/2771012

Tremelimumab and Durvalumab as First-line Therapy in Patients with Unresectable Hepatocellular Carcinoma (HIMALAYA Trial):

https://ascopubs.org/doi/10.1200/JCO.2022.40.4_suppl.379

Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma (IMbrave 150 Trial):

https://www.nejm.org/doi/full/10.1056/nejmoa1915745

Lenvatinib Combined With Transarterial Chemoembolization as First-Line Treatment for Advanced Hepatocellular Carcinoma (LAUNCH Trial):

https://ascopubs.org/doi/abs/10.1200/JCO.22.00392

Randomised, Multicentre Prospective Trial of Transarterial Chemoembolisation Plus Sorafenib as Compared with TACE Alone in Patients with Hepatocellular Carcinoma (TACTICS Trial):

https://pubmed.ncbi.nlm.nih.gov/31801872/

Uncoupling Immune Trajectories of Response and Adverse Events from Anti-PD-1 Immunotherapy in Hepatocellular Carcinoma:

https://pubmed.ncbi.nlm.nih.gov/35430299/

Personalised Versus Standard Dosimetry Approach of Selective Internal Radiation Therapy in Patients with Locally Advanced Hepatocellular Carcinoma (DOSISPHERE-01 Trial):

https://pubmed.ncbi.nlm.nih.gov/33166497/

Radiation Segmentectomy for Curative Intent of Unresectable Very Early to Early Stage Hepatocellular Carcinoma (RASER Trial):

https://www.thelancet.com/journals/langas/article/PIIS2468-1253(22)00091-7/fulltext

Immunotherapy and Transarterial Radioembolization Combination Treatment for Advanced Hepatocellular Carcinoma:

https://journals.lww.com/ajg/abstract/2023/12000/immunotherapy_and_transarterial_radioembolization.23.aspx

Find this episode on BackTable.com to see additional resources.

In this episode of the BackTable Podcast, host Dr. Jacob Fleming and guest Dr. Jack Jennings discuss advancements in interventional oncology, specifically regarding cryoablation for bone metastases. Dr. Jennings is an interventional musculoskeletal radiologist at Washington University School of Medicine and President of the American Society of Spine Radiology.

They discuss the results of the MOTION Study, the benefits of industry collaboration, and the future of robotic guidance systems in interventional procedures. They also explain techniques like hydrodissection and pneumodissection in detail. With constant advancements in technology such as guidance navigation systems to reduce pain from bone metastases, it is crucial for interventional radiologists to adapt to these changes. At the end of the episode the doctors give a shout out to the upcoming Society of Interventional Oncology (SIO) 2024 meeting and the enriching opportunities that it offers for interventional radiologists.

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CHECK OUT OUR SPONSOR

Boston Scientific Visual ICE Cryoablation System

https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html

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SHOW NOTES

00:00 - Introduction

02:25 - Overview of the MOTION Study

04:23 - Benefits and Challenges of Cryoablation

09:37 - Results of the MOTION Study

12:13 - Future of Interventional Oncology

19:38 - Role of Imaging Guidance in Cryoablation

23:07 - Future of Robotic Guidance Systems

31:40 - Importance of Industry Partnerships

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RESOURCES

Society of Interventional Oncology Annual Meeting, Long Beach, CA January 25th-29th:

https://www.sio-central.org/Events/Annual-Scientific-Meeting/Registration

Interventional Oncology MOTION Multicenter Study:

https://www.bostonscientific.com/en-EU/medical-specialties/interventional-radiology/interventional-oncology/latest-evidence/motion-study.html

Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial:

https://pubmed.ncbi.nlm.nih.gov/23065947/

Cryoablation Needles from Boston Scientific:

https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice/visual-ice-cryoablation-needles.htm

In this episode of the Backtable Podcast, guest host Dr. Paul Bhogal, a consultant interventional neuroradiologist at Royal London Hospital in the UK, and guests Dr. Piotr Walczak and Dr. Prakash Ambady discuss the potential of intra-arterial treatments combined with blood brain barrier (BBB) manipulation in treating various neurological conditions and tumors.

The trio of doctors discuss methods such as the use of hyperosmolar mannitol and focused ultrasound to breach the BBB and deliver drugs directly to the brain tissue. Dr. Walczak and Dr. Ambady also highlight their individual research areas, including therapies involving cell delivery and engineered cells. The conversation also covers potential risks and new perspectives in comparison to current techniques such as whole-brain radiation.

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RADPAD® Radiation Protection

https://www.radpad.com/

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SHOW NOTES

00:00 - Introduction

05:44 - Challenges of Treating Glioblastoma Multiforme

12:52 - Understanding the Blood Brain Barrier

18:30 - Strategies to Negate the Blood Brain Barrier

20:52 - Blood Brain Barrier Disruption Using Intra-Arterial Mannitol

26:35 - Infusion Rates and Magnetic Resonance Guidance

33:47 - Role of Radiolabel Studies in Drug Delivery

36:31 - Future of Therapeutic Agents Design

47:54 - Potential of Focused Ultrasound in Drug Delivery

56:10 - Exploring the Use of Cells in Drug Delivery

58:44 - Future of Intra-Arterial Interventions

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RESOURCES

Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma:

https://pubmed.ncbi.nlm.nih.gov/15758009/

Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomized phase III study: 5-year analysis of the EORTC-NCIC trial:

https://pubmed.ncbi.nlm.nih.gov/19269895/

REMOVAL OF RIGHT CEREBRAL HEMISPHERE FOR CERTAIN TUMORS WITH HEMIPLEGIA - PRELIMINARY REPORT:

https://jamanetwork.com/journals/jama/article-abstract/254927

Real-Time MRI Guidance for Reproducible Hyperosmolar Opening of the Blood-Brain Barrier in Mice:

https://www.researchgate.net/publication/328537972_Real-Time_MRI_Guidance_for_Reproducible_Hyperosmolar_Opening_of_the_Blood-Brain_Barrier_in_Mice

Dr. Piotr Walczak ResearchGate Profile:

https://www.researchgate.net/profile/Piotr-Walczak-6

Dr. Prakash Ambday ResearchGate Profile:

https://www.researchgate.net/profile/Prakash-Ambady

Maculopathy Associated With Osmotic Blood- Brain Barrier Disruption and Chemotherapy in Patients With Primary CNS Lymphoma:

https://pubmed.ncbi.nlm.nih.gov/32484895/

PET imaging of intra-arterial 89 Zr bevacizumab in mice with and without osmotic opening of the blood-brain barrier: distinct advantage of intra-arterial delivery:

10.2967/jnumed.118.218792

Safety of intra-arterial chemotherapy with or without osmotic blood–brain barrier disruption for the treatment of patients with brain tumors:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9307096/

Delivery of chemotherapeutics across the blood-brain barrier: challenges and advances:

https://pubmed.ncbi.nlm.nih.gov/25307218/

In this episode of The Backtable Podcast, host Dr. Aaron Fritts and guests Dr. Mahmood Razavi and Dr. Mark Garcia discuss the intricacies of owning and operating an outpatient-based lab (OBL). Dr. Razavi and Dr. Garcia are practicing interventional radiologists at Vascular and Interventional Specialists of Orange County (California) and American Vascular Associates (Florida), respectively.

The doctors explore the advantages of OBLs, including autonomy, flexibility, and patient satisfaction. They also delve into the challenges of financial sustainability, decision-making restrictions, and insurance navigation. The conversation revolves around the need for a solid business plan before stepping into OBL operation. This includes awareness of potential regulatory oversight, costs, and patient sources. They also discuss the impact of OBLs on healthcare, and they specifically warn that the lack of evidence-based practices might have adverse effects. The doctors propose solutions such as societal guidelines, required accreditation, and stringent care delivery.

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CHECK OUT OUR SPONSOR

Siemens Healthineers

https://www.siemens-healthineers.com/

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SHOW NOTES

00:00 - Introduction

04:26 - Pros and Cons of Owning and Operating in an OBL

11:07 - Financial Aspects and Profitability of OBLs

23:42 - Exploring Alternative Models for OBLs

32:33 - The Role of Societies in Guiding OBL Practices

36:27 - The Future of OBLs: Regulation, Consolidation, and Quality

42:59 - Exit Strategies and Future Considerations for OBLs

50:38 - Final Thoughts on OBLs and the Importance of Quality Care

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RESOURCES

Impact of Office Based Laboratories on Physician Practice Patterns and Outcomes after Percutaneous Vascular Interventions for Peripheral Artery Disease:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8555658/pdf/nihms-1524412.pdf

In this episode of The Backtable Podcast, host Dr. Michael Barraza and guest Dr. Brandon St. Amant have an in-depth discussion about QGenda, an online scheduling solution. Both doctors practice interventional radiology at Radiology Associates in Baton Rouge, Louisiana.

They discuss the initial setup process, from rule setting to managing shift assignments and creating transparency among the team. The key points of the conversation include the concept of the ‘holiday schedule’, the ‘buy sell system’ for open shifts, and making ‘longer schedules’ for predictability. The episode emphasizes the ongoing role of the scheduler and the need to build trust when transitioning to an electronic system like QGenda.

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CHECK OUT OUR SPONSORS

Medtronic HawkOne Directional Atherectomy System

https://www.medtronic.com/hawkone

Reflow Medical

https://www.reflowmedical.com/

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SHOW NOTES

00:00 - Introduction

03:08 - The Challenges of Manual Scheduling

05:00 - Transition to QGenda

09:34 - The Role of Excel in Scheduling

22:06 - Handling Holiday Schedules

26:50 - Buy-Sell System for Shifts

33:17 - Final Tips for Effective Scheduling

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RESOURCES

QGenda:

https://www.qgenda.com/