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Ep. 44 Coronary Calcium Modification: Treating the Impossible with Dr. Kate Kearney
When should you keep pushing and when should you walk away during a tough chronic total occlusion (CTO) case with heavy coronary calcification? On this episode of BackTable Cardiology, coronary CTO expert Dr. Kate Kearney from the University of Washington joins Dr. Hady Lichaa to define what makes a coronary PCI truly complex and to break down real-world strategies for managing ambiguous, heavily calcified lesions. The discussion emphasizes the uncertainty of achieving a good outcome and highlights the critical role of troubleshooting and dynamic decision-making in the cath lab.
---
Get the BackTable app
https://www.backtable.com/app
---
This podcast is supported by
Sponsor
https://shockwavemedical.com/
---
Timestamps
00:00 - Introduction
04:48 - Hard CTO Case Insights
08:43 - CTO vs IVL Safety And Predictability
15:18 - Atherectomy Lesion Length for Atherectomy
23:13 - Interpreting Calcium on Imaging
27:58 - D-Shaped Stents after Calcium Modification
30:19 - Left Main Bifurcation Strategy
35:31 - IVL Versus Atherectomy Sequencing
39:49 - When To Stop A Case
50:28 - Future Of IVL And Imaging
53:47 - Conclusion
---
More about this episode
Dr. Kearney shares practical strategies developed through real CTO case experience, including when to deploy dynamic stop-or-continue decision-making and how to leverage “phone a friend” safety rules for complex cases. She explains how intravascular lithotripsy (IVL) has made balloon-based calcium modification more predictable, improved stent results, and encouraged a multimodal approach, while early atherectomy still plays a role for deliverability and control. The discussion also covers imaging-driven criteria for intervention, D-shaped stent placement, and tailored planning for left main bifurcation or ostial circumflex lesions, highlighting the value of collaborative and evidence-based practice in advanced coronary intervention.
---
Resources
Dr. Hady Lichaa Physician Profile:
https://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa
Dr. Kate Kearny Physician Profile:
https://www.uwmedicine.org/bios/kathleen-kearney
ECLIPSE trial:
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 (Short-Cut Trial):
https://clinicaltrials.gov/study/NCT06089135
---
BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions.
Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.
► https://www.backtable.com/app
View all episodes
By BackTable Inc.When should you keep pushing and when should you walk away during a tough chronic total occlusion (CTO) case with heavy coronary calcification? On this episode of BackTable Cardiology, coronary CTO expert Dr. Kate Kearney from the University of Washington joins Dr. Hady Lichaa to define what makes a coronary PCI truly complex and to break down real-world strategies for managing ambiguous, heavily calcified lesions. The discussion emphasizes the uncertainty of achieving a good outcome and highlights the critical role of troubleshooting and dynamic decision-making in the cath lab.
---
Get the BackTable app
https://www.backtable.com/app
---
This podcast is supported by
Sponsor
https://shockwavemedical.com/
---
Timestamps
00:00 - Introduction
04:48 - Hard CTO Case Insights
08:43 - CTO vs IVL Safety And Predictability
15:18 - Atherectomy Lesion Length for Atherectomy
23:13 - Interpreting Calcium on Imaging
27:58 - D-Shaped Stents after Calcium Modification
30:19 - Left Main Bifurcation Strategy
35:31 - IVL Versus Atherectomy Sequencing
39:49 - When To Stop A Case
50:28 - Future Of IVL And Imaging
53:47 - Conclusion
---
More about this episode
Dr. Kearney shares practical strategies developed through real CTO case experience, including when to deploy dynamic stop-or-continue decision-making and how to leverage “phone a friend” safety rules for complex cases. She explains how intravascular lithotripsy (IVL) has made balloon-based calcium modification more predictable, improved stent results, and encouraged a multimodal approach, while early atherectomy still plays a role for deliverability and control. The discussion also covers imaging-driven criteria for intervention, D-shaped stent placement, and tailored planning for left main bifurcation or ostial circumflex lesions, highlighting the value of collaborative and evidence-based practice in advanced coronary intervention.
---
Resources
Dr. Hady Lichaa Physician Profile:
https://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa
Dr. Kate Kearny Physician Profile:
https://www.uwmedicine.org/bios/kathleen-kearney
ECLIPSE trial:
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 (Short-Cut Trial):
https://clinicaltrials.gov/study/NCT06089135
---
BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions.
Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.
► https://www.backtable.com/app