Dr. Darren Klass, interventional radiologist at the University of British Columbia, discusses best practices in aortic dissection management. Topics include intraoperative decision-making, the importance of intravascular ultrasound, treating acute complicated aortic dissections, and follow-up protocols.

En este nuevo episodio de BackTable, el Dr. Fernando Gómez Muñoz y la Dra. Sara Lojo Lendoiro profundizan en el complejo y específico campo de la radiología intervencionista pediátrica.Al enfatizar las diferencias existentes entre los pacientes adultos y los niños, el Dr. Gómez Muñoz destaca la necesidad de capacitación y enfoques especializados para el manejo de casos pediátricos, especialmente en términos de variantes propias de la edad del paciente como la volemia o el tamaño de los vasos. Se examinan críticamente los desafíos en los procedimientos intervencionistas, particularmente en relación con las complejidades propias del trabajo con pacientes pediátricos y la dificultad añadida de los materiales necesarios. Además, el Dr Gómez Muñoz comparte su trayectoria profesional, su paso por el Great Ormond Street Hospital de Londres y su continuo aprendizaje de colegas de todo el mundo.En el podcast también se explora la necesidad de una colaboración multidisciplinar y se analiza la relación entre los radiólogos intervencionistas y los cirujanos pediátricos. Se subraya la importancia de una comunicación clara con las familias de los pacientes durante procedimientos o diagnósticos particularmente complejos, afirmando que la atención al paciente comienza con el manejo de las emociones y expectativas de los propios médicos.---SHOW NOTES00:00 - Introducción a la radiología intervencionista pediátrica01:27 - Comprender las diferencias entre pacientes adultos y pediátricos03:08 - Desafíos en radiología intervencionista pediátrica08:29 - El papel de la formación y la especialización13:25 - Cómo afrontar las emergencias médicas pediátricas19:02 - La importancia del enfoque multidisciplinario en la atención pediátrica26:23 - El futuro de la radiología intervencionista pediátrica42:44 - Conclusión: La importancia de la radiología intervencionista pediátrica

In this episode, guest host Dr. Dana Dunleavy and guest Dr. Douglas Beall delve into the transformative potential of neuromodulation in the treatment of chronic pain, particularly for painful diabetic neuropathy (PDN). Dr. Beall is an interventional musculoskeletal radiologist practicing at Oklahoma Spine in Edmond, Oklahoma.Dr. Beall recounts his journey, from his beginnings in the military to his experiences with navigating institutional resistance to his clinical practice, and finally the process of moving to private practice. He discusses the positive impact of spinal cord stimulation on patients with PDN and reflects on its effectiveness in reducing pain and improving neurologic function. He underscores the crucial role of interventional radiologists in managing PDN, while also advocating for the integration of these specialists in pain management clinics. Dr. Beall argues that interventional radiologists possess unique skill sets adept for neuromodulation, which opens up new treatment possibilities in the process. He shares insights on the evolution of spinal cord stimulation technology, reimbursement considerations, and the importance of clinical trials in refining treatment approaches. The episode ends with an invitation for interested physicians to participate in professional forums and learn more about this burgeoning field.---CHECK OUT OUR SPONSORNevro HFX Spinal Cord Stimulatorhttps://www.hfxforpdn.com---SHOW NOTES00:00 - Introduction02:30 - Challenges and Triumphs of a Solo Practice14:44 - Evolution of Neuromodulation in Practice17:05 - Impact of Neuromodulation on Painful Diabetic Neuropathy31:53 - Unique Mechanism of High Frequency Neuromodulation46:02 - Role of Interventional Radiologists in Neuromodulation54:11 - Future of Neuromodulation in Interventional Radiology---RESOURCESDouglas Beall, MD Research Gate Profile:https://www.researchgate.net/scientific-contributions/Douglas-P-Beall-39583252Long-term efficacy of high-frequency (10 kHz) spinal cord stimulation for the treatment of painful diabetic neuropathy: 24-Month results of a randomized controlled trial:https://pubmed.ncbi.nlm.nih.gov/37536514/High-Frequency 10-kHz Spinal Cord Stimulation Improves Health-Related Quality of Life in Patients With Refractory Painful Diabetic Neuropathy: 12-Month Results From a Randomized Controlled Trial:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9256824/Neuromodulation Interventions for the Treatment of Painful Diabetic Neuropathy: a Systematic Review:https://link.springer.com/article/10.1007/s11916-022-01035-9High-frequency spinal cord stimulation at 10 kHz for the treatment of painful diabetic neuropathy: design of a multicenter, randomized controlled trial (SENZA-PDN):https://link.springer.com/article/10.1186/s13063-019-4007-y

Interventional cardiologist Dr. Thomas Davis discusses the Pioneer Plus Catheter for treating critical limb ischemia. He explains the reorientation technique to stay in the true lumen while treating chronic total occlusion. Dr. Davis shares post-procedure patient management and imaging follow-up, emphasizing the opportunities to learn more about peripheral vascular disease treatment.

In this episode of the BackTable Podcast, guest host Dr. Krishna Amuluru interviews Dr. Fawaz Al-Mufti about recent trials on large core strokes and how they may impact practice. Dr. Al-Mufti is a practicing neurointerventionalist and serves as the Associate Chair of Neurology for Research at New York Medical College.Dr. Al-Mufti examines the cost-effectiveness and socioeconomic implications of successful treatment of patients with large core strokes. The doctors highlight various stroke thrombectomy trials including the RESCUE-Japan, SELECT2 Trial, and TENSION trials. The discussion also covers how these findings affect thrombectomy expansion in lower resource settings and the future outlook of endovascular thrombectomy procedures.---CHECK OUT OUR SPONSORRADPAD® Radiation Protectionhttps://www.radpad.com/---SHOW NOTES00:00 - Introduction02:53 - Large Ischemic Core Infarcts06:06 - The Importance of ASPECTS11:59 - Large Ischemic Core Trials23:37 - Socioeconomic Implications of Thrombectomy38:08 - The Future of Thrombectomy---RESOURCESMission Thrombectomy:https://missionthrombectomy.org/The Alberta Stroke Program Early CT score (ASPECTS): A predictor of mortality in acute ischemic stroke:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8515558/Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomized trials (HERMES Study):https://doi.org/10.1016/S0140-6736(16)00163-XThrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging (DEFUSE III Trial):https://www.nejm.org/doi/full/10.1056/nejmoa1713973Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct (DAWN Trial):https://www.nejm.org/doi/full/10.1056/nejmoa1706442Endovascular Therapy for Acute Stroke with a Large Ischemic Region (RESCUE-Japan Trial):https://www.nejm.org/doi/full/10.1056/nejmoa2118191Trial of Endovascular Thrombectomy for Large Ischemic Strokes (SELECT2 Trial):https://www.nejm.org/doi/full/10.1056/NEJMoa2214403TESLA Trial: Rationale, Protocol, and Design:https://www.ahajournals.org/doi/10.1161/SVIN.122.000787Endovascular thrombectomy for acute ischaemic stroke with established large infarct: multicentre, open-label, randomized trial (TENSION Trial):https://www.sciencedirect.com/science/article/pii/S0140673623020329Evaluation of acute mechanical revascularization in large stroke (ASPECTS ⩽5) and large vessel occlusion within 7 h of last-seen-well: The LASTE multicenter, randomized, clinical trial protocol:https://pubmed.ncbi.nlm.nih.gov/37462028/Trial of Endovascular Therapy for Acute Ischemic Stroke with Large Infarct (ANGEL-ASPECT Trial):https://www.nejm.org/doi/full/10.1056/NEJMoa2213379Acute endovascular stroke therapy (Dr. Mike Chen Review):https://pubmed.ncbi.nlm.nih.gov/20535000/Mechanical thrombectomy is cost-effective versus medical management alone around Europe in patients with low ASPECTS (European Cost Effectiveness Study):https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10313965/Mechanical Thrombectomy Global Access For Stroke (MT-GLASS): A Mission Thrombectomy (MT-2020 Plus) Study:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10313965/Noncontrast Computed Tomography vs Computed Tomography Perfusion or Magnetic Resonance Imaging Selection in Late Presentation of Stroke With Large-Vessel Occlusion:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8576630/

Dr. Sameh Sayfo and Dr. Nicolas Shammas discuss critical limb ischemia (CLI) and the use of lasers in below-the-knee (BTK) treatment. They explain the challenges of treating infrapopliteal disease and the efficacy of laser atherectomy for calcified lesions. The ongoing multicenter study on the Auryon laser atherectomy system in CLI patients is reviewed, along with advice on building a strong CLI program.

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.---CHECK OUT OUR SPONSORCook Medical Zilver PTXhttps://www.cookmedical.com/zilverptxbacktable---SHOW NOTES00:00 - Introduction09:31 - Understanding Drug Coated Balloons and Stents14:29 - The Paclitaxel Controversy19:30 - Stenting Algorithm for Fem-Pop Disease23:55 - Impact of Lithotripsy on Drug Delivery26:02 - Predictability Models for Revascularization29:14 - Economic Considerations in Drug Eluting Stent Usage31:33 - Highlighting Trials on Drug Coated Technology and Drug Eluting Stents37:08 - Future Technologies: Drug on Stent Grafts and Spot Stenting---RESOURCESZilver 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.118.011245Durable 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/fulltextOutcomes 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)32262-1SPORTS 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

Dr. Alim Mitha, a cerebrovascular, endovascular, and skull base neurosurgeon and biomedical engineer, discusses the development of biodegradable flow diverters for cerebral aneurysms. He explains the challenges in designing a polymer-based flow diverter and the importance of matching its degradation time with the aneurysm healing time. The podcast also explores advice for turning ideas into ventures and upcoming clinical trials for biodegradable flow diverters.

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.---CHECK OUT OUR SPONSORSSiemens Healthineershttps://www.siemens-healthineers.com/Varian, a Siemens Healthineers companyhttps://www.varian.com/products/interventional-solutions/embolization-solutions---SHOW NOTES00:00 - Introduction03:33 - Site of Service and Its Impact on Payment06:15 - Role of CMS in Determining Payment09:09 - Role of Advocacy Groups in Site of Service Payments17:51 - Future of Site of Service Payments20:17 - Negative Consequences of Site of Service Differentials24:01 - Closing Remarks and Reflections---RESOURCESCMS.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

Dr. Merve Ozen, an interventional radiologist, discusses the Percunav system, a needle guidance technology that combines different imaging techniques for precise procedures and reduced radiation exposure. She explains the various applications such as biopsies, drain placements, and challenging interventions. The learning curve and challenges of incorporating this technology into practice are explored. Future applications and the potential of ultrasound imaging are discussed, as well as the decreasing use of navigation software for IR guidance.