Episode # 3 • 17 Jan 2025
Understanding the Use of Ultra-High Pressure Balloons in PCI
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.
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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
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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.
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