Ep. 25 IVL & Atherectomy: Techniques for Complex PCI with Dr. Yousif Ahmad

How do imaging, intravascular lithotripsy, and equipment selection come together to effectively target coronary calcium? In this episode of BackTable, interventional cardiologists Dr. Robert Riley (Overlake Medical Center in Bellevue, Washington) and Dr. Yousif Ahmad (UCSF) trade techniques and discuss various aspects of calcium modification in complex percutaneous coronary intervention (PCI). --- This podcast is supported by: Shockwave Medicalhttps://shockwavemedical.com/ --- SYNPOSIS The discussion begins with an overview of intravascular lithotripsy (IVL), including its mechanism of action, ideal lesion characteristics, and performance across varying calcium morphologies. The conversation then expands to comparative decision-making among atherectomy, specialty balloons, and IVL, emphasizing how intravascular imaging informs procedural planning and real-time optimization. Key clinical data are reviewed, including the Disrupt CAD I-IV series as well as findings from the Short-Cut and VICTORY trials. The episode concludes with a forward-looking discussion on emerging technologies and the ongoing challenge of treating calcified nodules, one of the most demanding substrates in coronary intervention. --- TIMESTAMPS 00:00 - Introduction04:16 - Complex PCI and Calcium Modification Tools04:43 - Intravascular Lithotripsy (IVL) Insights and Evolution12:08 - Calcium Modification Algorithms and Techniques27:24 - IVUS vs. OCT Imaging and Specialty Balloons32:12 - Challenges in Implementing New Techniques37:09 - Influential Studies in Calcium Modification40:52 - Recent Studies: Short-Cut and VICTORY53:11 - Future of Calcium Modification Technologies57:48 - Final Thoughts --- RESOURCES Dr. Robert Rileyhttps://www.scai.org/robert-f-riley-md-ms-fscai Dr. Yousif Ahmadhttps://profiles.ucsf.edu/yousif.ahmad Intravascular imaging-guided coronary drug-eluting stent implantation: an updated network meta-analysishttps://pubmed.ncbi.nlm.nih.gov/38401549/ Coronary intravascular lithotripsy for severe coronary artery calcification: The Disrupt CAD I-IV trialshttps://www.sciencedirect.com/science/article/abs/pii/S1553838924000769 Orbital Atherectomy vs. Conventional Balloon Angioplasty in Severely Calcified Coronary Arteries Prior to DES Implantation - ECLIPSEhttps://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 - A Randomized Controlled Trial (Short-Cut)https://clinicaltrials.gov/study/NCT06089135 The Value of IVL Compared To OPN Non-Compliant Balloons for Treatment of RefractorY Coronary Lesions (VICTORY) Trial (VICTORY)https://clinicaltrials.gov/study/NCT05346068