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.---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.

Exploring the use of lidocaine injection for migraines, discussing its effectiveness and duration of headache relief. Exploring the mechanism of action and therapeutic effect of lidocaine in nerve blocks. Exploring the symptoms and treatment options for status migrainosus. Discussing the dosage, administration, and results of lidocaine injection for migraine management. Discussing the potential of early intervention for migraines and modifying the natural history of the disease. Inviting listeners to a brain conference in London and reminding them to subscribe, rate, and share the podcast.

The podcast discusses the importance of educating medical oncologists about local regional therapy in the treatment of hepatocellular carcinoma. It also explores the role of immunotherapy and the potential of combination therapies. The chapter highlights the molecular subtypes of HCC and the need for therapy decisions based on them. Furthermore, it explores the benefits of combining local regional therapy with immunotherapy. The podcast also focuses on the challenges and ablative techniques in treating multifocal HCC.

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.---CHECK OUT OUR SPONSORBoston Scientific Visual ICE Cryoablation Systemhttps://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html---SHOW NOTES00:00 - Introduction02:25 - Overview of the MOTION Study04:23 - Benefits and Challenges of Cryoablation09:37 - Results of the MOTION Study12:13 - Future of Interventional Oncology19:38 - Role of Imaging Guidance in Cryoablation23:07 - Future of Robotic Guidance Systems31:40 - Importance of Industry Partnerships---RESOURCESSociety of Interventional Oncology Annual Meeting, Long Beach, CA January 25th-29th:https://www.sio-central.org/Events/Annual-Scientific-Meeting/RegistrationInterventional Oncology MOTION Multicenter Study:https://www.bostonscientific.com/en-EU/medical-specialties/interventional-radiology/interventional-oncology/latest-evidence/motion-study.htmlPercutaneous 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

Dr. Piotr Walczak and Dr. Prakash Ambady discuss intra-arterial approaches in tumor therapy, overcoming the blood-brain barrier using hyperosmolar mannitol and focused ultrasound, cell delivery, and engineered cells. They explore potential risks, new perspectives, and advancements in drug delivery to the brain tissue.

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.---CHECK OUT OUR SPONSORSiemens Healthineershttps://www.siemens-healthineers.com/---SHOW NOTES00:00 - Introduction04:26 - Pros and Cons of Owning and Operating in an OBL11:07 - Financial Aspects and Profitability of OBLs23:42 - Exploring Alternative Models for OBLs32:33 - The Role of Societies in Guiding OBL Practices36:27 - The Future of OBLs: Regulation, Consolidation, and Quality42:59 - Exit Strategies and Future Considerations for OBLs50:38 - Final Thoughts on OBLs and the Importance of Quality Care---RESOURCESImpact 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

Dr. Brandon St. Amant, an interventional radiologist, and Dr. Michael Barraza discuss scheduling strategies in the medical field. They delve into the challenges of manual scheduling, transitioning to online scheduling with QGenda, handling holiday schedules, implementing a buy-sell system for shifts, and providing final tips for effective scheduling.