13 Oct 2026
Ep. 56 Interventional Techniques for Chronic Thromboembolic Pulmonary Hypertension with Dr. Riyaz Bashir
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.
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Timestamps
00:00 - Introduction02:48 - Procedural Setup and Vascular Access06:31 - Sheath in Sheath Technique11:20 - Guide Catheter Selection17:53 - Wire Selection and Balloon Undersizing22:12 - Crossing Chronic Total Occlusions27:25 - Pulmonary Collaterals and Flush Occlusions32:33 - Guide Extensions and Contrast Reduction36:38 - Distal Perfusion Pressure Targets41:26 - Pressure Wire Selection and Wire Management45:54 - Balloon Sizing and Reperfusion Pulmonary Edema54:04 - Hemoptysis and Gelatin Sponge Embolization1:02:32 - Closing Remarks
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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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Resources
Mizoguchi H, Ogawa A, Munemasa M, Mikouchi H, Ito H, Matsubara H. Refined Balloon Pulmonary Angioplasty for Inoperable Patients With Chronic Thromboembolic Pulmonary Hypertension. Circ Cardiovasc Interv. 2012https://doi.org/10.1161/CIRCINTERVENTIONS.112.971077 Auger WR, et al. Balloon Pulmonary Angioplasty for Treatment of Chronic Thromboembolic Pulmonary Hypertension: Statement From the BPA-CTEPH Alliance. JACC Cardiovasc Interv. 2026https://doi.org/10.1016/j.jcin.2026.02.033 Nasri A, Bashir R, Lakhter V. Management of Complications of Balloon Pulmonary Angioplasty. Card Electrophysiol Clin. 2025https://doi.org/10.1016/j.ccep.2024.12.015 Lang IM, et al. Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: Results of an International Multicenter Prospective Registry. J Am Coll Cardiol. 2025https://doi.org/10.1016/j.jacc.2025.04.021 Aggarwal V, et al. Status and Future Directions for Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Disease With and Without Pulmonary Hypertension. A Scientific Statement From the American Heart Association. Circulation. 2024https://doi.org/10.1161/CIR.0000000000001197 Inami T, et al. Pulmonary Edema Predictive Scoring Index (PEPSI), a New Index to Predict Risk of Reperfusion Pulmonary Edema and Improvement of Hemodynamics in Percutaneous Transluminal Pulmonary Angioplasty. JACC Cardiovasc Interv. 2013https://doi.org/10.1016/j.jcin.2013.03.009 BackTable Cardiology Episode 36. Understanding CTEPH, Diagnostic and Interventional Techniqueshttps://www.backtable.com/shows/cardiology/podcasts/36/understanding-cteph-diagnostic-interventional-techniques Dr. Riyaz Bashir, Mayo Clinic, Jacksonvillehttps://www.mayoclinic.org/biographies/bashir-riyaz-m-b-b-s-m-d/bio-20590757 Dr. Hady Lichaa, BackTable contributor pagehttps://backtable.com/shows/vi/contributors/dr-hady-lichaa Dr. Hady Lichaa, Ascension Saint Thomas Hearthttps://healthcare.ascension.org/doctors/1336267533/hady-t-lichaa-murfreesboro-tn
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