Ep. 412 Intervencionismo Pediátrico: No Kits For Peds with Dr. Fernando Gómez Muñoz

In this episode, host Dr. Aaron Fritts is joined by interventional cardiologists Dr. Sameh Sayfo (Baylor Scott & White in Plano, TX) and Dr. Nicolas Shammas (Cardiovascular Medicine in Davenport, IA) for a discussion about critical limb ischemia (CLI) and the use of lasers in below-the-knee (BTK) treatment. To start, Dr. Shammas explains that infrapopliteal disease is difficult to treat due to the high rate of total occlusions and the high degree of medial calcinosis. Next, he gives an introduction to laser atherectomy for certain plaque locations and morphologies, and he describes previous studies that have shown its efficacy for calcified lesions. Intravascular ultrasound (IVUS) can also help guide vessel sizing, plaque morphology, and appropriate device selection. Dr. Shammas believes that the current atherectomy devices on the market are easy to learn to use and can be incorporated into any CLI program. The doctors discuss the ongoing multicenter study on outcomes of the Auryon laser atherectomy system in CLI patients. Dr. Shammas reviews the study design, proposed endpoints, and current data on 30 day outcomes. We end the episode with advice on building a strong CLI program, which includes multidisciplinary collaboration, advocating for resources, a variety of different tools, and appropriate management of cardiovascular risk factors. --- CHECK OUT OUR SPONSOR AngioDynamics Auryon System https://www.auryon-system.com/ --- SHOW NOTES 00:00 - Introduction 04:18 - Current Treatment Limitations for Infrapopliteal Disease 07:38 - Laser Atherectomy for Calcified Lesions 12:10 - Learning Curve for Laser Atherectomy Devices 15:38 - 30-Day Results of the Auryon BTK Study 23:35 - Technical Approach and Tools for Infrapopliteal Segments 29:00 - Upcoming Developments in CLI Treatment 31:33 - Advice for Building a CLI Program --- RESOURCES Calcium 360 Trial: https://pubmed.ncbi.nlm.nih.gov/22891826/ Auryon Laser Atherectomy System: https://www.angiodynamics.com/product/auryon/ Nexcimer Laser Atherectomy System: https://www.usa.philips.com/healthcare/product/HCIGTDPHLLSRSYSTM/laser-system-hcigtdphllsrsystm 30-Day Results of the Auryon BTK Study: https://www.jacc.org/doi/10.1016/j.jacc.2023.09.194 Midwest Cardiovascular Research Foundation: http://www.mcrfmd.com/ Life-BTK Study: https://www.cardiovascular.abbott/us/en/patients/treatments-therapies/peripheral-artery-disease/life-btk.html Promise II Study: https://www.nejm.org/doi/full/10.1056/NEJMoa2212754 BackTable Ep. 350- Building a CLI Program with Dr. Zola N’Dandu: https://www.backtable.com/shows/vi/podcasts/350/building-a-cli-program

23 Tammi 202440min

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 SPONSOR Cook Medical Zilver PTX https://www.cookmedical.com/zilverptxbacktable --- 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 --- 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

22 Tammi 202444min

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. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- 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 --- RESOURCES University of Calgary Creative Destruction Lab: https://creativedestructionlab.com/locations/calgary/ The Brain Conferences: https://www.fens.org/meetings/the-brain-conferences

17 Tammi 202438min

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 SPONSORS Siemens Healthineers https://www.siemens-healthineers.com/ Varian, a Siemens Healthineers company https://www.varian.com/products/interventional-solutions/embolization-solutions --- 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 --- 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

15 Tammi 202427min

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

12 Tammi 202424min

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. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- 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 --- 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: qureshi@gmail.com 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

10 Tammi 202444min

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. --- CHECK OUT OUR SPONSOR AstraZeneca https://www.astrazeneca-us.com/ --- 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 --- 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.

8 Tammi 20241h 13min

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 SPONSOR Boston Scientific Visual ICE Cryoablation System https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html --- 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 --- 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

5 Tammi 202436min