BackTable Vascular & Interventional

With the annual trend of fluctuating reimbursement rates, have you been on the fence about turning your OBL into an ASC? Make sure your OBL is prepared for the surprising changes in coding coming in 2026. In this episode, Dr. Mary Costantino partners with fellow OBL owner Dr. Goke Akinwande and revenue cycle management expert Laurie Bouzarelos to review the new CPT code changes and how they translate to OBL and ASC reimbursement.---SYNPOSISDr. Akinwande discusses many positive takeaways after diving into the recent Medicare documents, and highlights key shifts. He believes these changes to add-on codes and territories means one thing: CLI is being heard. The upcoming code changes improve delineation of vascular territories, differentiating between "simple" (stenosis) and "complex" (CTO) procedures. These changes are aimed at rewarding physicians performing the difficult CLI work while decreasing reimbursement for more straightforward cases.Beyond the CPT code specifics, the conversation also covers real-world implications for OBL owners. Dr. Akinwande explains why these changes might narrow the reimbursement gap between OBLs and ASCs, prompting him to warn against ASC conversion. Laurie Bouzarelos provides guidance on implementation, stressing the importance of updating charge masters, reviewing payer contracts for "gap fill" clauses, and monitoring payments once the new codes go live. The episode ends with a discussion on obstacles in billing, collections, and the need for physicians to master the business side of their practice to ensure financial success.---TIMESTAMPS00:00 - Introduction04:37 - 2026 CPT Changes Overview07:18 - Simple vs. Complex Codes13:16 - Key Add-on Codes19:52 - OBL vs. ASC Conversion?24:56 - IVL Reimbursement Trends29:18 - Update Your Charge Master41:41 - Pricing & Medicare Year46:39 - Billing & Collections Reality

Is meningeal artery embolization the key to ending the cycle of chronic subdural hematomas? In this episode of the Back Table Podcast, Dr. Paul Gullota from Ochsner Health joins host Michael Barraza to share his technical insights on middle meningeal artery embolization, including patient workup, procedure technique, and post-operative care.---SYNPOSISThe episode begins with a discussion on the evolving role of middle meningeal artery embolization in preventing chronic subdural recurrence. The doctors talk through patient selection and procedural planning for middle meningeal artery embolization, emphasizing the importance of assessing collateral pathways and hemorrhage laterality. Dr. Gullota shares his access techniques, microcatheter and embolic options, and the critical role of teamwork with neurosurgery. He also shares his approach to navigating complex vascular anatomy as well as ensuring appropriate patient follow up.---TIMESTAMPS00:00 - Introduction03:12 - Middle Meningeal Artery Embolization: Rationale and Process04:17 - Patient Evaluation and Procedure Steps06:09 - Outpatient Procedures and Billing07:06 - Candidates for Embolization Post-Evacuation07:56 - Unilateral vs. Bilateral Embolization10:34 - Procedure Techniques and Tools19:48 - Post-Procedure Care and Follow-Up21:35 - Final Thoughts and Conclusion

From longitudinal monitoring to complex interventions, type II endoleaks often require an individualized approach. In this episode of BackTable, host Dr. Sabeen Dhand welcomes Dr. Matt Givens, Chief of Interventional Radiology at the New Orleans VA and faculty at Louisiana State University Health, to discuss the intricacies of type II endoleak management and repair techniques.---SYNPOSISThe conversation begins with a walkthrough of Dr. Givens’s firstline operative approach, which involves entering the inferior mesenteric artery and choosing a microcatheter that allows for entry into the sac and nidus. The doctors cover nuances in choosing and planning transarterial, translumbar, and transcaval approaches. Dr. Givens also details his embolics of choice, his preferred tools for direct sac puncture, and the rationale behind his embolization endpoints.---TIMESTAMPS00:00 - Introduction 08:12 - Imaging and Follow-Up Protocols16:27 - Transarterial Techniques for Endoleak Management33:45 - Techniques for Targeting and Embolization35:34 - Challenges and Solutions in Embolization36:57 - Transcaval and Translumbar Approaches39:09 - Complications and Case Studies53:58 - Building a Collaborative Practice56:09 - Conclusion

PERT Consortium 2025 gives interventionalists the reins to tackle even the toughest saddle pulmonary embolisms. In this episode of the BackTable Podcast, host Dr. Aaron Fritts welcomes interventional radiologist Dr. Osman Ahmed and interventional cardiologist Dr. Jonathan Paul to discuss their experiences at the annual PERT Consortium in San Diego, and offer their perspectives on the latest developments in pulmonary embolism (PE) treatment.---SYNPOSISThe doctors delve into advancements and trials within the PE treatment space, including new devices and clinical studies that are set to shape the future of pulmonary embolism care. The conversation highlights the value of collaboration between interventional specialties, the safety and efficacy of various PE interventions, and the growing trend of using combined therapies. They also provide updates on their ongoing innovation with Flow Medical, describing their philosophy and motivation for developing a new device for PE treatment that incorporates real-time pulmonary artery pressures, mean systolic and diastolic pressures, and a potential for AI utilization in the future. ---TIMESTAMPS00:00 - Introduction01:23 - PERT Consortium Highlights02:11 - Emerging Clinical Trials and Innovations03:59 - Thrombectomy Devices and Market Trends12:37 - Flow Medical: Origin and Updates19:37 - Advanced Data Tracking in Cardiology20:45 - Remote Monitoring and Mobile Integration22:45 - Cardiologists’ Data-Driven Approach23:10 - Upcoming Studies and Data Insights24:10 - Interventional Radiology and Cardiology Collaboration25:07 - Access to Care and Procedure Adoption27:32 - Final Thoughts---RESOURCESPulmonary Embolism Response Team (PERT) Consortiumhttps://pertconsortium.org/ Flow Medicalhttps://www.flowmedical.co/ PEERLESS RCThttps://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.072364RESCUE-IIhttps://www.jacc.org/doi/10.1016/j.jacadv.2025.101789 PEERLESS II https://www.jscai.org/article/S2772-9303(24)01053-6/fulltextPulmonary Embolism - Thrombus Removal With Catheter-Directed Therapy (PE-TRACT)https://clinicaltrials.gov/study/NCT05591118 The HI-PEITHO Studyhttps://www.bostonscientific.com/en-EU/medical-specialties/vascular-surgery/venous-thromboembolism-portal/pulmonary-embolism/clinical-data/hi-peitho.htmlPRAGUE-26https://eurointervention.pcronline.com/article/design-and-rationale-of-prague-26-a-multicentre-randomised-trial-of-catheter-directed-thrombolysis-for-intermediate-high-risk-acute-pulmonary-embolism Pulmonary Embolism - Thrombus Removal With Catheter-Directed Therapy (PE-TRACT)https://clinicaltrials.gov/study/NCT05591118 Aaron Fritts, MDhttps://www.backtable.com/shows/vi/contributors/dr-aaron-fritts Osman Ahmed, MDhttps://jointvascular.com/team/osman-ahmed-m-d-fcirse/ Jonathan Paul, MDhttps://www.uchicagomedicine.org/find-a-physician/physician/jonathan-d-paul

From the angio suite to the boardroom, what qualities of an interventional radiologist translate into pioneering leadership? Tune in to hear from Dr. Howard Chrisman, the President and CEO of Northwestern Medicine, as he discusses his journey with hosts Dr. Sabeen Dhand and Dr. Aaron Fritts.---SYNPOSISDr. Chrisman shares his inspiring journey from a student with an initial interest in veterinary medicine to a leader in interventional radiology (IR) and healthcare administration. He recounts his pivotal experiences, including his mentorship under prominent IRs, his decision to pursue an MBA, and the importance of building trust and fostering relationships within clinical and administrative realms. He details his learnings in developing self-awareness, being open to multiple viewpoints, and amplifying your voice as an IR. The discussion touches on the future of interventional radiology, the impact of artificial intelligence on the field, and the essential qualities for leadership in healthcare. Dr. Chrisman also reflects on the significance of learning from mistakes and the role of mentorship in his career, emphasizing the value of collaboration and empathy in achieving success.---TIMESTAMPS00:00 - Introduction 03:21 - Mentorship and Career Development09:55 - Balancing Bias and Decision Making18:32 - Building Trust and Value in Healthcare23:13 - The Future of Radiology and AI Integration28:48 - The Role of MBAs in Healthcare32:24 - Reflections on Leadership and Career35:43 - Conclusion and Final Thoughts

When a patient presents with portal vein thrombosis (PVT), how do you decide between anticoagulation, intervention, and adjunct therapies? In this episode, Dr. Vijay Ramalingam, vascular and interventional radiologist from Beth Israel Deaconess Medical Center, joins Backtable host Dr. Chris Beck to share his approach to evaluation and management of both acute and chronic PVT.---SYNPOSISThe discussion begins with an overview of the Splanchnic Vein Thrombosis Multidisciplinary Clinic at Beth Israel– a collaboration between Interventional Radiology, Hepatology/Gastroenterology, Surgery and Hematology. Dr. Ramalingam details the clinic's workflow, from initial case conference to the comprehensive single-day patient workup that includes imaging, lab work, and consultations with all three specialties. He shares his algorithm for treatment decisions, breaking down the distinct management pathways for patients with and without cirrhosis, and for those with acute vs. chronic thrombosis.Finally, Dr. Ramalingam details his portal vein recanalization technique during procedure, providing a step-by-step guide to his preferred dual-access approach for complex cases, including his method for trans-splenic access and his trick on how to safely close the splenic tract. He also explains when it’s appropriate to use adjunctive therapies like suction thrombectomy and catheter-directed lysis, and describes preliminary data showing that their comprehensive approach leads to a change in management for about 40% of patients.---TIMESTAMPS00:00 - Introduction05:35 - Splanchnic Vein Thrombosis Multidisciplinary Clinic22:24 - Multidisciplinary Approach26:17 - PVT Classification38:47 - Treatment Evaluation and Intervention44:21 - Alternative Treatment Options for PVT49:00 - Procedural Techniques59:53 - Adjunct Techniques and Case Studies01:02:58 - Review of Preliminary Data & Final Thoughts

This week’s episode is a masterclass on vascular anomaly treatment. Brush up on your malformations with Dr. Cliff Weiss, the Director of the Vascular Anomaly Center at Johns Hopkins. He shares next-level techniques, precision diagnostics, and his 'gold standard' approach to alcohol sclerotherapy. --- This podcast is supported by:RADPAD® Radiation Protectionhttps://www.radpad.com/ --- SYNPOSIS The episode begins with the most vital component of patient care: establishing a correct diagnosis through proper classification. Dr. Weiss shares his philosophy that “MRI is a conversation” - not just an image, detailing the specific MRI protocols to confidently make a diagnosis over 90% of the time. He then shares an overview of the classification system, differentiating vascular tumors like hemangiomas from high-flow and low-flow vascular malformations. Dr. Weiss explores a wide array of treatment strategies tailored to each diagnosis. He walks through his techniques for treating low-flow malformations with sclerotherapy—using agents like alcohol, doxycycline, and bleomycin based on a lesion’s location and characteristics—and his use of cryoablation for vascular tumors. He then dives into the creative and high-stakes approaches for treating AVMs, comparing transvenous and transarterial embolization with agents like Onyx and coils, before concluding with his predictions on the future of IR in the field. --- TIMESTAMPS 00:00 - Introduction 02:36 - Vascular Anomaly Center at Johns Hopkins06:33 - Vascular Anomaly & Malformation Diagnosis with Imaging09:04 - Classifying Vascular Anomalies15:55 - Vascular Tumors18:46 - Low-Flow Malformations27:58 - Needle Placement29:56 - Retro-orbital & ENT Malformations32:44 - AVM Treatment Strategy40:41 - Following up with Patients

What happens when the doctor suddenly becomes the patient? In this episode of the BackTable podcast, host Dr. Ally Baheti interviews Dr. Nicholas Hanson, an interventional and diagnostic radiologist from Oregon, about a life-changing event that dramatically altered his career.---SYNPOSISDr. Hanson describes the circumstances surrounding a severe car accident that resulted in a traumatic brain injury and subsequent medical complications, including the discovery of a heart aneurysm. He shares the challenges of his recovery, his struggle with insurance companies, and the emotional and professional toll of his experiences. Dr. Hanson provides valuable insights into the importance of disability insurance and the often overwhelming process of navigating healthcare systems. The discussion also touches on the ongoing debate about the separation of interventional radiology from diagnostic radiology and how sudden life events can impact one's career in medicine.---TIMESTAMPS00:00 - Introduction01:19 - The Life-Changing Event09:28 - Navigating Insurance and Disability16:39 - The Future of IR and Career Advice21:50 - Struggles with Disconnection28:56 - The Road to Recovery35:20 - Reflecting on the Journey37:42 - Closing Thoughts and Future Hopes

Is microwave ablation only for simple liver tumors, or can it be a versatile ‘Swiss Army knife’ for a wide range of complex cases? In this episode, Dr. Driss Raissi of the University of Kentucky returns to BackTable to join host Dr. Chris Beck for a deep dive into advanced and unconventional microwave ablation techniques. They cover strategies for tackling a wide range of cases, from desmoid tumors to enterocutaneous fistulas.---This podcast is supported by:Medtronic Emprinthttps://www.medtronic.com/emprint---SYNPOSISDr. Raissi shares his ‘pre-burn’ technique that desiccates tissue and reduces complications like capsular burst and bleeding. He elaborates on his method for tackling large liver tumors with a single probe through overlapping ablations, needle placement techniques and his ‘lung seal technique’ to prevent pneumothorax. Dr. Raissi also shares how his previous experience in the ICU promotes close communication with anesthesiologists and how he ups his ablation game through collaboration, optimizing conditions for safe and effective ablation.The episode explores a series of unique, real-world applications beyond the usual scope of IRs. Dr. Raissi walks us through his novel approach to challenging cases, including cauterization of enterocutaneous fistulas, endometriomas and desmoid tumors. He also compares using microwave or cryoablation for renal cell carcinoma, explaining thought processes based on lesion location and the need for speed and simplicity. The discussion provides an overview of ablation physics and careful techniques that expand treatment possibilities for IR patients.---TIMESTAMPS00:00 - Introduction 04:08 - Advanced Techniques for Liver Tumor Ablation06:06 - Pre-Burning Ablation and Ablating a Range of Lesions16:38 - Lung Ablation22:00 - Partnering with Anesthesia28:53 - Managing Postoperative Pain and Nerve Injuries29:42 - Treating Enterocutaneous Fistulas, Endometriomas & Desmoid Tumors38:49 - Adrenal Gland Ablation: A Case Study44:50 - Microwave vs. Cryoablation for Renal Cell Carcinoma49:06 - Preventing Pneumothorax in Lung Ablation

So you’ve placed the biliary drain—are your patients getting the follow up that they need? In this episode, Dr. Ahsun Riaz from Northwestern University joins host, Dr. Christopher Beck, for a deep dive into biliary strictures—how to manage them effectively and navigate the potential complications of this challenging chronic condition.---This podcast is supported by:Medtronic Emprinthttps://www.medtronic.com/emprint---SYNPOSISDr. Riaz takes us inside his journey of building a specialized hepatobiliary service at Northwestern, highlighting innovative practices like endoscopic techniques and radiofrequency ablation. He unpacks the nuances of distinguishing benign from malignant strictures, shares technical pearls for patient management, and emphasizes the power of collaboration with Gastroenterology to improve long-term patient outcomes. He outlines key technical considerations, including the use of the Hudson loop and strategic equipment selection to address intra-procedural challenges. He further emphasizes the importance of comprehensive patient care—ensuring appropriate follow-up, minimizing drain duration, and prioritizing quality of life as essential components of optimal management.---TIMESTAMPS00:00 - Introduction01:28 - Biliary Drain Management04:18 - Approach to Biliary Strictures19:20 - Endoscopic Evaluation and Techniques27:53 - Practical Tips and Experiences with Endoscopy30:39 - Post-Procedure Follow-Up and Patient Outcomes31:16 - Learning from the Hudson Roof Technique32:48 - Innovations in Benign Stricture Management36:48 - Endobiliary Ablation: Equipment and Procedure40:23 - The Double Dragon Technique Explained46:02 - Considerations for Malignant Biliary Stenting52:37 - Future Innovations and Collaborative Care

Could hospital employment be your path to practicing 100% interventional radiology (IR)? In this episode of BackTable, host Dr. Ally Baheti sits down with Dr. Ryan Trojan, an interventional radiologist at INTEGRIS Health in Oklahoma City, to discuss the pros and cons of hospital employment contracts in IR.---This podcast is supported by:Medtronic Emprinthttps://www.medtronic.com/emprint---SYNPOSISThe physicians take a deep dive into the evolving employment models in the IR landscape. Dr. Trojan shares his journey from a private IR-DR blended practice to becoming directly employed by a hospital, highlighting the financial challenges, contract negotiations, and administrative dynamics along the way. He explains the growing loss of IR talent to lucrative diagnostic contracts and emphasizes the importance of advocating for IR’s value to hospital systems, from decreasing length of stay to supporting ECMO, trauma, and transplant services. The discussion covers financial security, administrative support, and the benefits of having aligned goals with the hospital in order to grow an IR practice. Dr. Trojan also addresses common misconceptions about IR and private practice, detailing how the landscape is likely to change over the coming years, and offers advice on navigating employment contracts. ---TIMESTAMPS00:00 - Introduction03:02 - Transition to Hospital Employment12:15 - Advocating for IR’s Value16:07 - Contract Structures and Compensation Models25:07 - Benefits and Downsides of the Employed Model28:27 - Negotiating Contracts and Fair Market Value41:12 - Conclusion---RESOURCESDr. Trojan’s contact information:ryan.trojan@integrishealth.org

Should MRI-guided interventions be on your radar? Find out why the future of interventional radiology might lie in MRI guidance with experts Dr. Clifford Weiss from Johns Hopkins University and Dr. David Woodrum from the Mayo Clinic.---This podcast is supported by:Medtronic Emprinthttps://www.medtronic.com/emprint---SYNPOSISThe physicians join host Dr. Chris Beck to explore the benefits of MRI guided procedures, including superior imaging capabilities and reduced radiation exposure. Dr. Weiss and Dr. Woodrum detail the challenges and barriers to adoption, like the intricate set up needed to protect equipment from a strong magnetic field. They highlight the significant technological advancements and collaborations between MRI and device companies that are set to make MRI guided interventions more accessible and practical for everyday use. They also discuss the reimbursement paradigm for MRI guided biopsies and how similar the algorithm is to CT guided procedures.The episode closes with unique insights for young physicians on training opportunities and the promising future of MRI guided interventions for trainees looking to bring a different approach to their future practices.---TIMESTAMPS00:00 - Introduction05:13 - The Advantages of MRI in Interventional Radiology13:44 - Technical Insights and Challenges of MRI Guided Procedures18:46 - Future Prospects and Industry Developments in MRI Guided Interventions31:01- Development of Hybrid MRI Rooms48:19 - Economic Considerations and Reimbursement52:33 - Community Support for MRI Interventions56:41 - Conclusion and Final Thoughts---RESOURCESInternational Society for Magnetic Resonance in Imaging:https://www.ismrm.org/

What tricks do you have up your sleeve to help you get through tough cases? In this special episode of the BackTable Podcast, Drs. Ally Baheti, Mike Barraza, and Chris Beck spotlight the most creative and practical pearls from the 2025 BackTable Tips & Tricks competition, showcasing standout submissions and clever techniques shared by their peers. --- SYNPOSIS Guests include leading interventional radiologists like Dr. Aaron Fischman from Mount Sinai, who reveals his unique wire-shaping method—bending it like a question mark to navigate challenging, angulated vessels during prostate artery embolization. From Jefferson, Dr. Sean Maratto walks us through his innovative retrograde approach to placing double J stents. And from Ochsner Health, Dr. Tyler Sandow brings invaluable guidance on achieving direct portal vein access for TIPS. --- TIMESTAMPS 00:00 - Introduction 03:30 - Favorite Tips and Tricks06:11 - Practical Techniques and Personal Experiences15:41 - A Humbling Experience with Phil Banov16:02 - The Bumper Stitch Technique17:55 - Direct Portal Access for TIPS19:35 - Navigating Challenging Cases24:11 - Radial vs. Femoral Access Debate27:33 - Innovative Techniques and Tricks29:36 - Final Thoughts and Gratitude

Before the advent of TIPS, mesocaval shunts were considered a less popular option for managing portal hypertension. But today, could they serve as a lifeline when no other choices remain? This week on BackTable, Drs. Omar Chohan and Harris Chengazi (Great Lakes Medical Imaging) join host Dr. Chris Beck to discuss the evolving role of endovascular mesocaval shunts, covering patient selection, clinical decision-making, and technical pearls. --- SYNPOSIS In this episode, the hosts delve into the specialized procedure of meso-caval shunts, focusing on its applications for patients with portal hypertension who have no other viable options. This discussion includes detailed case studies, such as one involving a woman with autoimmune hepatitis and another with pancreatic cancer, showcasing the practical challenges and innovative solutions in creating these shunts. In each case, they detail the rationale for patient selection, difficult anatomy, procedural steps, and resolution of symptoms like recurrent ascites and variceal bleeding. The episode emphasizes the importance of pre-procedure planning, collaboration, and precise imaging, utilizing advanced tools like the 4D CT scanner. The conversation also highlights the compassionate motivation behind these complex procedures, aimed at improving patients' quality of life. --- TIMESTAMPS 00:00 - Introduction 03:07 - Historical Context and Indications06:49 - Case 1: Patient with Refractory Ascites34:00 - Case 2: Recurrent GI Bleeding41:16 - Case 3: TIPS Consult - Pancreatic Cancer and Duodenal Varices47:44 - Lessons, Pearls, and Tips56:13 - Final Thoughts --- RESOURCES A Case Series of Dr. Chengazi's Mesocaval Shunts on X:https://x.com/chengazimd/status/1966337167879438571 Episode 573 Portal Hypertension Treatment Strategies:https://www.backtable.com/shows/vi/podcasts/473/portal-hypertension-treatment-strategies-ir-hepatology-perspectives TIPS University Freshman Year:https://www.backtable.com/shows/vi/podcasts/123/tips-university-freshman-year-referrals-pre-op-workup TIPS University Sophomore Year:https://www.backtable.com/shows/vi/podcasts/124/tips-university-sophomore-year-basic-procedure-technique TIPS University Junior Year:https://www.backtable.com/shows/vi/podcasts/125/tips-university-junior-year-advanced-techniques-ice-splenic-access TIPS University Senior Year:https://www.backtable.com/shows/vi/podcasts/126/tips-university-senior-year-gunsight-technique-splenic-closure

What does it really take to break away from the hospital system and build your own interventional radiology practice?---This podcast is supported by:Medtronic Emprinthttps://www.medtronic.com/emprint---SYNPOSISIn this episode, host Dr. Ally Baheti interviews Dr. Kartik Kansagra and Dr. Harout Dermendjian, independent interventional radiologists from California and founders of EVS LA. They share their journey in establishing and growing an independent IR practice, discussing their training at Kaiser Sunset, the steps they took to develop their own practice, and the challenges they faced along the way. Emphasizing the importance of training, clinician communication, and balancing inpatient and outpatient services, they offer valuable insights and advice for new IR professionals considering a similar path.---TIMESTAMPS00:00 – Introduction and opening remarks01:23 – Early training and transition08:54 – Clinical vs. non-clinical IR practice differences13:05 – Achieving parity with other interventional specialties17:47 – Building insurance contracts and following up with patients24:31 – Setting boundaries and documenting clinical decisions34:32 – Final advice and closing words from the guests

Below the knee atherectomy is a hot topic right now in the vascular community. Why is it so controversial? Dr. Anahita Dua, vascular surgeon at Mass General, joins host Dr. Sabeen Dhand to explore the utility of this technique and the pressing need for more Level I evidence in this space. --- This podcast is supported by:AngioDynamicshttps://www.auryon-system.com/ --- SYNPOSIS The conversation dives into the controversial role of below-the-knee atherectomy in limb salvage, an area where data has long been debated. Dr. Dua, principal investigator of the AMBITION BTK Trial—the first randomized controlled trial comparing below-the-knee atherectomy to angioplasty alone—introduces the trial and explains how it fits into the current body of literature. Together, the doctors review past evidence, current practice, and the future outlook for tibial interventions. Dr. Dua outlines the wide range of techniques and clinical strategies used to manage PAD, and stresses the importance of physician engagement with the NIH and research community to establish stronger, evidence-based protocols. She also shares her candid thoughts on the most overrated and underrated devices in tibial intervention, highlighting atherectomy’s potential role in vessel preparation before below-the-knee treatment. --- TIMESTAMPS 00:00 - Introduction04:55 - Current State of Evidence and Challenges10:54 - Heterogeneity in PAD Treatment14:26 - Need for National Metrics and Standardization20:51 - AMBITION BTK Trial and Importance27:23 - Potential Outcomes and Implications30:18 - Trial Design34:56 - Advice for Practitioners37:36 - Underrated and Overrated Devices41:50 - Conclusion --- RESOURCES AMBITION BTK Trial:https://www.angiodynamics.com/studies/ambition-btk/

From new techniques to evolving best practices–are you up to date with the latest developments in carotid artery stenting? In this episode, Dr. Wayne Olan, Interventional Neuroradiologist and the director of Minimally Invasive Neurosurgery at George Washington University joins Dr. Michael Barraza for a discussion on the latest innovations and evolving techniques in carotid artery stenting. --- This podcast is supported by:RADPAD® Radiation Protectionhttps://www.radpad.com/ --- SYNPOSIS Dr. Olan opens the conversation with a historical perspective on the evolution of carotid stenting, tracing advancements from early techniques to modern devices. He then talks through referral patterns, noting that the majority originate from cardiologists. Dr. Olan emphasizes the importance of meticulous periprocedural planning and comprehensive post-procedural management. Central to this discussion is the critical role of antiplatelet therapy, including strategies for addressing Plavix non-responders, such as the use of Integrilin. The discussions also covers advanced techniques in carotid artery stenting, including the utilization of the Aptus sheath and the Contego stent system. He underscores the importance of mastering the available tools, understanding patient-specific factors, meticulous procedural planning, and always maintaining a contingency plan. He concludes the discussion by exploring emerging trends and the future potential of outpatient carotid stenting. --- TIMESTAMPS 00:00 - Introduction02:44 - The Importance of Stroke Intervention07:16 - Carotid Stenting: Evolution and Techniques13:29 - Challenges and Collaborations in Carotid Interventions16:17 - Technical Insights and Best Practices25:24 - Choosing the Right Wire for Carotid Procedures25:53 - Anticoagulation and Filter Wire Techniques28:30 - Managing Stent Placement and Distal Protection30:54 - Handling Carotid Bifurcation and Skull Base Lesions38:43 Dealing with Tandem Occlusions42:06 - Future Trends in Outpatient Procedures44:43 - Addressing Re-stenosis and Vertebral Lesions45:44 - Conclusion and Final Thoughts

What does it really take to bring cutting-edge vascular care to the most underserved corners of the rural South? In this episode of the BackTable Podcast, host Dr. Ally Baheti welcomes interventional cardiologist Dr. Ash Sastry and interventional radiologist Dr. Sree Nair to discuss the financial and regulatory side of providing care to underserved rural populations in North Carolina, Virginia, and Georgia. --- SYNPOSIS The doctors delve into the operations and challenges of running an office-based lab (OBL) and the potential transition to an ambulatory surgical center (ASC). This episode covers topics like certificate of need (CON) laws, reimbursement issues, and the importance of multidisciplinary collaboration. The conversation offers insights into the practical and regulatory hurdles faced in delivering high-quality vascular care in rural settings. --- TIMESTAMPS 00:00 - Introduction02:14 - Challenges in Rural Healthcare09:00 - Understanding Certificate of Need (CON) Laws11:30 - The Financial Struggles of OBLs19:58 - Advocacy and Legislative Efforts27:53 - Future Prospects and Final Thoughts

What piques your clinical suspicion for biliary structure? And when is interventional endoscopy the preferred approach? Fine tune your diagnostic and treatment algorithm with Dr. Premal Trivedi from the University of Colorado and host Dr. Christopher Beck as they go in-depth on the management of biliary strictures.---This podcast is supported by:RADPAD® Radiation Protectionhttps://www.radpad.com/---SYNPOSISThe doctors first break down the signs and clinical picture that alert them to a possible biliary stricture. Dr. Trivedi then explains the steps of his workup and preferred imaging, and also describes his threshold to pursue percutaneous transhepatic cholangiography (PTC), especially in diffuse conditions like primary sclerosing cholangitis. Dr. Trivedi also walks through his procedural steps for PTC and drain placement, covering his best practices and typical intraoperative decision making.Dr. Trivedi then explains the role of angioplasty over the course of longitudinal treatment, balloon choice, and his upper limit of catheter upsizing. The doctors also delve into the role of interventional endoscopy and tackling complications such as bleeding and tube leakage. The conversation offers valuable insights for trainees and practitioners alike, and highlights future advancements in biliary interventions.---TIMESTAMPS00:00 - Introduction06:19 - Approach to Biliary Strictures08:10 - Workup and Imaging for Biliary Strictures20:41 - Accessing the Biliary System27:14 - Crossing the Obstruction: Next Steps33:22 - Endoscopic Evaluation and Its Role47:14 - Complications and Pain Management53:40 - Future of Biliary Management54:55 - Conclusion and Final Thoughts