Ep. 52 Advanced Techniques in Retroflex Circumflex Lesions with Dr. Sripal Bangalore

What are the critical steps for delivering a stent in tortuous, calcified coronary lesions, and how do you adapt when the anatomy fights back? This week on the BackTable Cardiology Podcast, Dr. Hady Lichaa hosts interventional cardiologist Dr. Sripal Bangalore, director of the Cath Lab and CTO program at Bellevue Hospital, to discuss planning and performing complex percutaneous coronary intervention (PCI). Their conversation centers on advanced strategies for retroflex circumflex lesions approached via right radial access, with a focus on careful angiogram review, managing severe tortuosity, and post-procedure antithrombotic regimens. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by Teleflex https://www.teleflex.com/ --- Timestamps 00:00 - Introduction 02:21 - Pre-PCI Case Planning 07:23 - Wires And Tracking Tricks 11:22 - Guide Extensions Masterclass 16:58 - Dampening And Safe Injection 20:19 - Calcified Lesion Escalation 26:55 - Stent Selection And ORSIRO 31:03 - Post-Procedure DAPT Strategy 37:38 - Perforation Rescue Playbook 44:28 - Conclusion --- More about this episode Dr. Bangalore offers tips for advancing through obtuse angles, expediting PCI when guide pressure dampens, and pivoting when challenges arise. He shares experience-driven advice on early use of guide extensions, best practices for avoiding hydraulic dissection, and escalation strategies for calcified lesions. The episode also covers stent selection, managing leaks after covered stent deployment, and the importance of intravascular imaging guidance and minimizing triple therapy duration. Dr. Bangalore closes with pearls for new operators and emphasizes that in complex interventions, adaptability and imaging are key. --- Resources Dr. Sripal Bangalore’s Physician Profile https://nyulangone.org/doctors/1902066871/sripal-bangalore Dr. Hady Lichaa’s Physician Profile https://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa The Elusive Late Benefit of Biodegradable Polymer Drug-Eluting Stents https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.038378?doi=10.1161/CIRCULATIONAHA.118.038378 --- BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app