Episode # 52 • 15 Sept 2026
Advanced Techniques in Retroflex Circumflex Lesions
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.
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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
Resources
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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.
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