Episode # 3 • 17 Jan 2025
Interventional Techniques for Chronic Thromboembolic Pulmonary Hypertension
What does it actually take to open a chronically occluded pulmonary artery without pushing the patient into reperfusion pulmonary edema? On this episode of BackTable Cardiology, Dr. Hady Lichaa interviews Dr. Riyaz Bashir, interventional cardiologist and vascular medicine specialist at Mayo Clinic in Jacksonville, about the real-world, table-side technique of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension (CTEPH). They walk through vascular access, telescoping sheath setup, right heart catheterization, pressure wire guidance, balloon sizing, and step-by-step planning for each lobe and lesion.
Timestamps
00:00 - Introduction
02:48 - Procedural Setup and Vascular Access
06:31 - Sheath in Sheath Technique
11:20 - Guide Catheter Selection
17:53 - Wire Selection and Balloon Undersizing
22:12 - Crossing Chronic Total Occlusions
27:25 - Pulmonary Collaterals and Flush Occlusions
32:33 - Guide Extensions and Contrast Reduction
36:38 - Distal Perfusion Pressure Targets
41:26 - Pressure Wire Selection and Wire Management
45:54 - Balloon Sizing and Reperfusion Pulmonary Edema
54:04 - Hemoptysis and Gelatin Sponge Embolization
1:02:32 - Closing Remarks
Resources
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More about this episode
Dr. Bashir describes a technique he has simplified over ten years, built around a single principle that the goal of the procedure is perfusion rather than a better looking angiogram. He explains why early sessions use deliberately undersized balloons to restore flow safely, how these lesions behave like scar tissue, and why retrograde approaches are risky in fragile pulmonary vessels. The discussion covers practical strategies for keeping distal pressure low, managing hemoptysis with balloon tamponade and gelatin sponge embolization, and staging treatment over several sessions. The discussion closes with advice on mechanical circulatory support planning and the judgment, preparation, and teamwork that make high-risk BPA safe and effective.
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