Episode # 44 • 21 Jul 2026
Coronary Calcium Modification: Treating the Impossible
When should you keep pushing and when should you walk away during a tough chronic total occlusion (CTO) case with heavy coronary calcification? On this episode of BackTable Cardiology, coronary CTO expert Dr. Kate Kearney from the University of Washington joins Dr. Hady Lichaa to define what makes a coronary PCI truly complex and to break down real-world strategies for managing ambiguous, heavily calcified lesions. The discussion emphasizes the uncertainty of achieving a good outcome and highlights the critical role of troubleshooting and dynamic decision-making in the cath lab.
This podcast is supported by
Timestamps
00:00 - Introduction
04:48 - Hard CTO Case Insights
08:43 - CTO vs IVL Safety And Predictability
15:18 - Atherectomy Lesion Length for Atherectomy
23:13 - Interpreting Calcium on Imaging
27:58 - D-Shaped Stents after Calcium Modification
30:19 - Left Main Bifurcation Strategy
35:31 - IVL Versus Atherectomy Sequencing
39:49 - When To Stop A Case
50:28 - Future Of IVL And Imaging
53:47 - Conclusion
Resources
You may also like
More about this episode
Dr. Kearney shares practical strategies developed through real CTO case experience, including when to deploy dynamic stop-or-continue decision-making and how to leverage “phone a friend” safety rules for complex cases. She explains how intravascular lithotripsy (IVL) has made balloon-based calcium modification more predictable, improved stent results, and encouraged a multimodal approach, while early atherectomy still plays a role for deliverability and control. The discussion also covers imaging-driven criteria for intervention, D-shaped stent placement, and tailored planning for left main bifurcation or ostial circumflex lesions, highlighting the value of collaborative and evidence-based practice in advanced coronary intervention.
The Materials available on BackTable are provided for informational and educational purposes only and are not a substitute for the independent professional judgment of a qualified healthcare professional in diagnosing or treating patients. Any opinions, statements, or views expressed are those of the individual contributors and do not necessarily reflect those of the publisher, platform, or any affiliated organization.