Ep. 54 Understanding the Use of Ultra-High Pressure Balloons in PCI with Dr. Deepak Kapoor

When a coronary lesion won’t open at conventional pressures, what can an ultra-high pressure balloon do differently? On this episode of BackTable Cardiology, host Dr. Hady Lichaa welcomes Dr. Deepak Kapoor, interventional cardiologist at the Medical College of Georgia at Augusta University, to discuss the science, safety, and real-world applications of ultra-high pressure (UHP) balloons in calcified coronary intervention. Dr. Kapoor walks through the evolution of balloon design, the main scenarios where UHP balloons are most useful, and the technical details that set these devices apart from standard non-compliant balloons and other calcium modification tools. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by RADPAD® Radiation Protection https://www.radpad.com/ --- Timestamps 00:00 - Introduction 04:00 - Three Key Indications for UHP Balloons 05:09 - Balloon Design, Material and Crossing Profile 07:32 - Intravascular Imaging and Case Planning 11:09 - Wire Compatibility and Buddy Wiring 13:55 - Calcium Morphology and Device Selection 17:43 - In-Stent Restenosis and Non-Dilatable Stents 20:33 - Sizing, Inflation Technique and Indeflators 28:21 - Post-Treatment Imaging and Calcium Fracture 31:16 - Perforation, Balloon Rupture and Dissection Risk 38:03 - Cost and Procedural Control 40:20 - Future Calcium Modification Technologies 41:37 - Closing Remarks --- More about this episode The conversation covers IVUS-led planning, device selection for different calcium morphologies, inflation strategies, and practical tips to avoid complications like rupture or dissection. Dr. Kapoor shares his approach to in-stent restenosis, cost considerations, and what the future may hold for calcium modification. The conversation closes with advice for operators new to UHP balloons, the importance of post-procedure imaging, and how to stay safe when pushing past traditional pressure limits. --- Resources Very high-pressure dilatation for undilatable coronary lesions: indications and results with a new dedicated balloon (EuroIntervention, 2016) https://pubmed.ncbi.nlm.nih.gov/26111405/ Super high-pressure balloon versus scoring balloon to prepare severely calcified coronary lesions: the ISAR-CALC randomised trial (EuroIntervention, 2021) https://pubmed.ncbi.nlm.nih.gov/33258774/ Safety and efficacy of super-high pressure OPN balloon in patients with in-stent restenosis, an intracoronary imaging-based observational study (Scientific Reports, 2025) https://www.nature.com/articles/s41598-025-20488-7 VICTORY: intravascular lithotripsy versus super-high-pressure balloons in calcified and refractory coronary lesions (PCR, TCT 2025) https://www.pcronline.com/News/Congress-coverages/TCT/2025/VICTORY-Intravascular-lithotripsy-vs.-super-high-pressure-PTCA-in-calcified-and-refractory-coronary-lesions --- 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