BackTable / VI / Podcast / Transcript #353

Podcast Transcript: MicroCT for PAD: What You Need to Know

with Dr. John Rundback

In this episode, host Dr. Sabeen Dhand interviews Dr. John Rundback about analysis of arterial calcifications using microCT. You can read the full transcript below and listen to this episode here on BackTable.com.

(1) What is Micro-CT?

(2) Exploring PAD & Laser Atherectomy Effects with Micro-CT

(3) Insights from the B-LaserTM Atherectomy IDE Trial

(4) Auryon Laser Atherectomy with Micro-CT: A Novel Cadaveric Study

(5) Micro-CT and Medial Calcium Pattern Analysis

(6) Practical Atherectomy Device Selection for PAD

(7) Infrapopliteal PAD Treatment: Future Directions

This podcast is supported by:

AngioDynamics Auryon System

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MicroCT for PAD: What You Need to Know with Dr. John Rundback on the BackTable VI Podcast)

Ep 353 MicroCT for PAD: What You Need to Know with Dr. John Rundback

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[Dr. Sabeen Dhand]
I'm Sabeen as your host today and I'm ecstatic to welcome back the illustrious Dr. John Rundback from Advanced Interventional and Vascular Services in Holy Name Medical Center and American Endovascular and Amputation Prevention. Welcome back, John.

[Dr. John Rundback]
Thank you, Sabeen. The last time was terrific. I'm so glad to be back on this amazing podcast.

[Dr. Sabeen Dhand]
Thank you. Yes, our last time we recorded was almost exactly a year ago. We talked about new tools to treat FEM pop disease and it was actually one of our most popular episodes by the way, man. So thank you so much for that.

[Dr. John Rundback]
Awesome.

[Dr. Sabeen Dhand]
For our listeners, that was episode 212. Today we're going to take a closer look at calcium in arteries, and by closer, I mean much closer with micro-CT. You might be asking yourselves, what the hell is micro-CT? I'm asking myself that too. So we're going to get into that soon, but before that, how's the last year been treating you? How are you?

[Dr. John Rundback]
Oh, spectacular. We're in both the hospital and the office-based laboratory ambulatory surgery center, which is hybrid now. We're trying to do those sort of things that I think vascular specialists need to do, work in different environments, very high-end practice doing complex procedures. We've integrated TCAR now into our practice on a regular basis, which has been super nice along with everything else we are doing. It's been a good year.

[Dr. Sabeen Dhand]
That's great. In the last year, you actually-- before you were completely office-based outpatient, now you've been a hybrid program with a hospital?

[Dr. John Rundback]
Yes, well, we've always had hospitals. Obviously, we've always needed places to admit patients. So I've been at Holy Name for 17 years, but now we're pretty equally divided where we deploy our patients.

(1) What is Micro-CT?

[Dr. Sabeen Dhand]
That's great. Sometimes some cases need to be done in the hospital, like some of these complex cases. That's great that you have both options there. So, yes. Okay. Micro-CT. I mean, when I heard this topic, I heard micro-CT, I was thinking, is this some microscopic CT scanner? What is it?

[Dr. John Rundback]
You know, that's what I thought too originally. You're not alone in that. This really started, the genesis of this is that we do these interventions all the time, Sabeen, right? We're kind of told mechanisms of action, and we think we understand it, but we don't really understand these things on a fundamental level, what's really happening at that interface between our devices and the tissue, and what the result of that interaction is. So working in this particular case with AngioDynamics, we wanted to get a better understanding of the mechanism of action of their atherectomy device, the Auryon atherectomy.

We talked about how to do that, and came across some of the material which had been published by Shockwave, looking at disruption of calcium that was using micro-CT. Really, a lot of the credit here now goes out to Aloke Finn, who we reached out to at Cardiovascular Path, down in Gaithersburg, Maryland. We reached out to them.

Micro-CT is not a miniaturized CT scanner. As a matter of fact, it's sort of the opposite in the sense that obviously in a CT scanner, the subject is stationary and the image or the fluorosource or the X-ray source rotates in the gantry, and obviously, various technologies around that. In micro-CT, the X-ray source is stationary, but the object is rotating. So that's how you get the three-dimensional perspective. The difference is that, unlike a CAT scanner, which you get maybe 3 millimeter, if you really want to get thin cuts, 1 millimeter resolution, the resolution from micro-CT, which is a non-destructive imaging method, is in the range of 3 to 5 microns, with the Nikon device we use, and in some cases, as low as 1 micron. It's really a microscopic evaluation of the tissues.

(2) Exploring PAD & Laser Atherectomy Effects with Micro-CT

[Dr. Sabeen Dhand]
Okay. It's funny you talk about we don't know the process behind things, because it's true. I see a 2D black line, it's narrow. I put a balloon atherectomy, it gets bigger. We have IVUS and things like that, but yes, we don't know what's going on in that 1 micron, 3 micron level. The subjects that you're putting on this rotating table, is it like a cadaveric specimen after treatment, and it's a small, little piece of tissue, or what are you scanning?

[Dr. John Rundback]
Exactly. Micro-CT has been used in industry for many years. It's a very rapid technique. It allows a tremendous evaluation of just the internal structure of anything. It's used to look at baffles and microscopic structure of electronic equipment. In this case, yes, it was screened cadaver arteries. The arteries were screened based upon cardiovascular risk factors in the individuals while they were alive.

Those who had substantial risk factors suggesting atherosclerotic burden were then obtained, the limbs were obtained, and they were just subject to regular x-ray, those limbs, isolated limbs to see if there was indeed calcification, because that was our target, both for femoral popliteal, but particularly in this study for infrapopliteal or tibial calcification. Once we had cadaver limbs, and that's a challenging screening process in its own, to get limbs, subject them to x-ray, divide these into sections so we can have an idea where we can and can't apply our technology or do our experiment. Once we have that, then the arteries were actually isolated. They were dissected free from the limb. Now you had these calcified arterial segments laid out on the table.

[Dr. Sabeen Dhand]
Reminding me of anatomy lab in med school, dissecting these arteries out.

[Dr. John Rundback]
Exactly, exactly, but even then, they're sort of still attached to the tissue. These were just pieces of spaghetti, in essence. Separate arteries, obviously branching and everything else that arteries do, which we would then lay out. What we did is we then, because you want tissue support when you do interventions to kind of simulate real life, basically it's a gel matrix inside a water bottle, which is slid open. You lay the arteries inside this gel matrix.

So you have tissue support around the artery. You cannulate both ends. You have a pulsatile pump, and now you have flow through these arteries. In this particular work, since we thought that the medium inside the arteries might affect the results, we actually had human blood, whole blood, which we were circulating through the arteries.

[Dr. Sabeen Dhand]
Whoa. Okay. Now I get it. So you put basically this artery in a gel. It's like the connective tissue, and then it gives you some compliance when you start putting fluid through the artery so it plumps up, right? You're kind of recreating a little, let's say a cuff basically on the table. Okay. You're circulating human blood through that and you're doing interventions in that ex vivo experiment. Is that true?

[Dr. John Rundback]
Exactly. Under fluoroscopy with an OEC camera.

[Dr. Sabeen Dhand]
Oh, wow. Then what kind of interventions were you testing? Was it just anything? Balloon angioplasty, POBA, DCB, IVL, everything, or specifically you were looking at the atherectomy?

[Dr. John Rundback]
Yes. In this particular case, we were very interested in the impact of this atherectomy on medial calcium. Obviously when you're treating infrapopliteal work, which is what we like to use in particular the smaller laser, and this happened to be the Auryon platform, but this may apply to other technologies as well. It'll be interesting to see the differential impact of other technologies on medial calcium now compared to this experiment, but in this particular case, which was sponsored by AngioDynamics, we threaded this down into the tibial vessel and the goal was to see the impact of atherectomy on medial calcium.

We basically went ahead, did our angiogram, identified our segments, had different treatment groups and algorithms set up. Some were plain old balloon angioplasty, as a control. Completely untreated areas actually served as a better control. For instance, if there was disruption of calcium, was it just from our handling the specimen? Did we, in laying it down–

[Dr. Sabeen Dhand]
Did you crack it?

[Dr. John Rundback]
Crack it, right?

[Dr. Sabeen Dhand]
Yes, exactly.

[Dr. John Rundback]
Then obviously there's the treatment segments and then we subjected those treatment segments to different energies and algorithms, 50 millijoules alone, 60 millijoules alone,
50 and 60 millijoules, 50 millijoules with angioplasty to see where we had impact on calcium. Again, the goal was to reproduce the images that shockwave had had. You're probably also familiar with some of the work that CSI has done where they've looked at orbital atherectomy utilizing both OCT, I believe, and definitely IVUS. We have this change in this arc of calcium, but that's not as visually spectacular. When you do IVUS, okay, something is changing, it's reverberating a little bit differently, but you don't get those same pictures of disruption of calcium.

[Dr. Sabeen Dhand]
The resolution is just-- you have intimal calcification on an IVUS image. Everything else is shadowed out essentially, right? Before we go into the effects of the devices, when you first started looking at this, whether it's the ex vivo specimen or the micro-CT images, what did you learn on these arteries? Was there any big aha moments you said, "Oh, this is showing me something completely different pre-intervention?"

(3) Insights from the B-LaserTM Atherectomy IDE Trial

[Dr. John Rundback]
Well, let me step back even before that, because the aha moment, maybe it occurred a year or two earlier. When we brought over the Eximo platform, which was the Israeli platform, which is now the Auryon laser, which was purchased by AngioDynamics, I had been the international and principal investigator for that IDE study. We had a fair amount of calcium in that study, I believe 40% of patients had moderate to severe calcium. We also had other kind of plaque morphologies. We noticed a couple of interesting things. First of all, in both the IDE study and the subsequent registry, some patients get a DCB after atherectomy and angioplasty, some didn't. Some patients had calcium, some didn't. Our observation when we interpreted the data that there didn't seem to be a whole lot of difference in clinical outcomes at six months and a year in terms of restenosis, and obviously events, in patients who had DCB or didn't, and patients who had moderate to severe calcium versus lesser degree of calcium. That was sort of an aha moment there. Are we using this laser in a way, maybe it's not specific to this particular laser, but we think it is, that is obtaining a different result than we would have anticipated with other modes of atherectomy?

That was the first aha moment. Now, the next remarkable thing is we went back to AngioDynamics and said, "This looks a little bit different. We need to do some preclinical work. Would you support that?"

[Dr. Sabeen Dhand]
It's a big ask.

[Dr. John Rundback]
Right. It's a big ask. That's always a little bit of an iffy proposition because in general, especially when you've had fairly favorable results, companies are a little hesitant to open up the lid a little bit, look under the trunk and–

[Dr. Sabeen Dhand]
They already know it's working. Let's not rough the feathers, basically.

(4) Auryon Laser Atherectomy with Micro-CT: A Novel Cadaveric Study

[Dr. John Rundback]
Right. You don't want to maybe find something you didn't anticipate finding. They were really open to it, doing this and focus first on the idea of CT, because I'm sure you know, CT to me is the biggest barrier we have for infrapopliteal work. I have a joke. I say, you ever play rock, paper, scissors? Always choose rock.

[Dr. Sabeen Dhand]
It's a good one. It's a good choice. I always do that too.

[Dr. John Rundback]
Because as far as I could tell, rock always wins. So that was the milieu we wanted. To look at these arteries, it's interesting. First of all, they're very densely calcified specimens. You don't have that picture to show, and yet when you feel them, they don't feel like rigid tubes.

[Dr. Sabeen Dhand]
Sure. Sure. They don't feel like hard rock.

[Dr. John Rundback]

No. These are still arteries that are bending and folding and pliable. Although this is a lot of calcium, it doesn't externally affect the feel and the visual aspects, the optics of the artery, nor is it so rigid that just manipulating it cracked, as we said before, the calcium. So we were able to handle these specimens, lay them down and put them into the gel mold as we wanted to. That was interesting. No difficulty cannulating them with sheets on each end and tying them down. Obviously this is ex vivo. We would occasionally have some holes in the artery, which we had to sort of close up.

[Dr. Sabeen Dhand]
Okay. Little bleeders, little perforations.

[Dr. John Rundback]
It wasn't always the neatest experiment.

[Dr. Sabeen Dhand]
That's funny.

[Dr. John Rundback]
All in all, it worked very well. I think we were able to achieve our objectives. The other thing is, which is interesting, and this sort of a little bit of background is, Jihad Mustapha, he does extravascular ultrasound when he does his interventions. He has the good fortune, and some labs now do, of having an-- what do they call them? Interventional sonographer who's in the room watching this.

He had already had an observation that areas of calcium that were not that pulsatile when de novo, after he had gone and done atherectomy, were now pulsatile. He restored the compliance of the blood vessel. That's a little interesting because if you go back to basic science and physiology, that compliance of the vessel is directly related with production of nitrous oxide, vasodilatory factor, and anti-restenotic cytokines. There may be something just restoring the normal pulsatility and compliance of vessel in addition to somehow disrupting calcium to allow maximal luminal expansion.

(5) Micro-CT and Medial Calcium Pattern Analysis

[Dr. Sabeen Dhand]
All right. We all see these pretty pictures. If we look, and we'll include it on our podcast notes of what a micro-CT image looks like so people can see it. After you performed different procedures, including the Auryon laser, what did you find? Were there breaks in calcium? Did it restore the compliance like you're mentioning? Did you do anything bringing it back to as you described a white stop sign when the whole vessel was just calcium? Did you look at that too? Tell us your results.

[Dr. John Rundback]
Well, first of all, I learned that there's more than one type of medial calcium. As we get into this, medial calcium has many different patterns. There's a speckled pattern, which as you can imagine, just little islands. There is a shingle pattern, which looks like shingles on a roof, kind of overlapping. There's sort of a sheet pattern where there's non-congruous, incomplete curvilinear sheets, and then there's a plate pattern.

The plate pattern is really what we worry about. That's the worst form of Mönckeberg's medial calcification, because the plate generally is circumferential, uninterrupted, continuous calcium. That's the one that's preventing any pulsatility or expansion of the vessel. That's the one that's physically limiting us. When you go in there and you do your balloon, the balloon won't open. That's plate calcium.

[Dr. Sabeen Dhand]
Fluoroscopically, is that when we see medial calcinosis? Is that the tram tracking, or is there any way to see that plate-like calcification on a non-micro-CT image?

[Dr. John Rundback]
When you have very dense circumferential calcium, that's often plate, but not always plate calcium. The truth is both the sheet calcium and the shingle calcium can look fairly dense, but since it's not contiguous and you can't tell that in any one plane, there is still pulsatility. It is still not contiguous, so the vessel is still able to expand and be compliant. In those cases, generally the balloon will expand. It's when you have this solid kind of plate of calcium circumferentially. I'm not sure you can tell that entirely just by fluoro.

[Dr. Sabeen Dhand]
About these different patterns of medial calcification, what did you find with your results then after that?

[Dr. John Rundback]
When we do atherectomy, and again, we're talking about the Auryon here, but in general, if you think about it, we're giving a lot of energy into the artery, and obviously with laser in particular, there are various modes of tissue interaction. As we all know, you can have a photochemical effect, you can have a photothermal effect, and then you have a photomechanical effect. Each of these work differently, but even the fact that you have a photothermal effect, obviously you're imparting a lot of energy. When you're doing something like orbital atherectomy, this thing is rotating around.

Extirpated atherectomy is a little bit different because it's cutting, it's not delivering energy, but any of these things that are delivering modes of energy, that energy is not necessarily longitudinally transmitted. Previously, the idea is that there's probably radial transmission of that energy into the vessel wall, and that's been called pulsatile waves.

[Dr. Sabeen Dhand]
Okay. Outward.

[Dr. John Rundback]
Right, outward. CSI picked up on this as a mechanism of action whereby they're not just going ahead and sanding intimal calcium, but now they're having an impact on deeper calcium, which is why you can expand balloons at a lower inflation force than you would if you did not do orbital atherectomy. They already had this idea of pulsatile waves, and the belief was that laser is probably doing the same thing. It's a different outward radial force, it's not an orbiting solid crown, but there is tremendous energy being delivered. In the Auryon laser in particular, it's got an extremely short bandwidth, so it's a 10 nanosecond bandwidth.

Think about a jackhammer. You could take something that's sort of moving slowly and try to make your way through the pavement, and you'll make a dent, but with a jackhammer, this short pulse width, it's a very high focal delivery of energy briefly, and as a result, not only is that forward-directed energy to open up any forward-facing plaque, that's outwardly radiating, and that's the idea to get these pulsatile waves, which are disrupting the vessel wall. When we ran the Auryon laser, we found that there are a couple of dependent interactions.

First of all, the 50 millijoules was not as effective as the 60 millijoules, which supports this idea that you need more energy to disrupt the calcium. Secondly, we really only saw the effect on circumferential plate calcium, because otherwise, you have compliant tissue, which would just dissipate that outward radial force.

[Dr. Sabeen Dhand]
It'll absorb it.

[Dr. John Rundback]
Absorb it, right, or it would have give. In the circumferential plate calcium, when you use 60 millijoules, in every single analyzed segment, we saw in our disruption of calcium. What's really amazing is if you look at those micro-CT images, the longitudinal images or the inside-out images like you're looking down the vessel, it looks exactly the same as shockwave.

(6) Practical Atherectomy Device Selection for PAD

[Dr. Sabeen Dhand]
Interesting.

I want to kind of pull it back. Probably no one has access to a micro-CT in their lab. Guarantee no one who's listening on this podcast has that or can see this plate-like calcification, medial, et cetera. Coming back to a practical standpoint, one is, with your findings of using a laser and other atherectomy devices, do you need to make a difference between intimal and medial and decide on your atherectomy device based on that? To do that, would you use IVUS or what would you do?

[Dr. John Rundback]

This is not an IVUS podcast, but we use IVUS in almost every case. Obviously a lot of reasons to use IVUS, make sure you're intraluminal, first of all. Atherectomy is a very different value proposition if you're sub-intimal, although we do use it in selected cases if there's calcium to get an idea obviously of vessel size and determine calcium.

Absolutely. When we see patients who have a lot of calcium, now we're looking at calcium dedicated technologies, which might be orbital atherectomy or now based upon this data, it might be more Auryon or other forms of laser atherectomy. If we see a lot of intimal calcium and really just complete shadowing, like you said, now we're leaning more towards orbital atherectomy. Now we have to get that inner surface before we can ever have an impact. If we see deeper calcium, deep to the internal elastic lamina, that gray ring on IVUS, now those are ideal cases based upon our findings for this technology. What you said is exactly right. We did this study with an idea to finding a clinical implication. This wasn't just done in isolation.

The idea was how can we learn from this so that we could guide clinicians on what to do? That's exactly the point that we came up with. If you have a patient and you see this calcium and it's not predominantly intimal and circumferential calcium, that's a case that you want to make sure you go super slow so you deliver energy. B, you want to make sure you make a pass at least 60 millijoules so that you can treat that appropriately.

[Dr. Sabeen Dhand]
A follow-up question to that too, why not just turn up the energy all the way? What does the energy go up to above 60? Can it go to 80?

[Dr. John Rundback]
No, there's two settings, 50 and 60. The reason that we don't necessarily do that is that the unique thing about the Auryon laser, since it's a very, very short pulse width and it's delivering these bursts of energy is that it's actually on a fraction of the time. Because it's on a fraction of the time, there's a large amount of time for tissue cooling. So the predominant effect is photo-mechanical and not photo-thermal, because as you know, thermal injury has its own long-term impact on producing restenosis. That's why we generally start low. By starting low, you're avoiding thermal injury. If you need to then you can go a little bit higher, certainly if you want to maybe get a larger lumen, but when you have calcium, you need to use the 60.

[Dr. Sabeen Dhand]
Again, I'm more familiar with the Spectranetics/Phillips laser where that had different settings as two different numbers where you can go up to even 80. Now, how does that compare? Is it still doing the jackhammer effect you're talking about and delivering energy in a photo-mechanical way to the medial and maybe even other adventitial or intimal layers?

[Dr. John Rundback]
Yes, obviously you have the frequency and the fluence that you're adjusting on the Phillips laser. The fluence is basically the size of the micro bubble at the end, and the frequency is going to be the mechanical effect of that. Either way, the pulse width on that laser is more in the order of 100, or even more, I think it's even more than that, nanoseconds. Whereas the pulse width on the Auryon laser is 10 nanoseconds.

There's going to be much, much more thermal delivery with that. Yes, you can dial it up, but by dialing it up, you're actually getting a lot of thermal energy delivered into the vessel wall, in theory. Again, a lot of this is kind of in theory. It's hard to test this specifically. You can't put a little temperature probe, but–

[Dr. Sabeen Dhand]
You can put it in your bottle with the gel.

[Dr. John Rundback]
Right, exactly.

[Dr. Sabeen Dhand]
Give it a try. No, it's very interesting. I'll be honest, in my practice, where we have a ton of tibial disease, a ton of calcium, I've always been under the impression of, if I'm doing atherectomy, my first thing is CSI. I think CSI, orbital atherectomy is my go-to because I have been so disappointed with other technologies with heavy calcium in the tibials. It's a tough thing. I've always asked my friends, Kumar, all these other people, Mark, Mike Watts, do you guys use laser and stuff? They'll say yes, and then I'll try the laser that I'm familiar with, and it just didn't work. That's why I always go back to orbital atherectomy.

(7) Infrapopliteal PAD Treatment: Future Directions

[Dr. Sabeen Dhand]
Now we've been using shockwave a little, but it's annoying when you have a shorter balloon, and I want to treat a 150, 200 millimeter length vessel, but you can't use that short balloon, and I know they're developing longer ones. It's interesting to see your development here. It's opening my eyes to see, maybe I'll explore laser for tibials. There's a lot more stuff we need to know, but aside from that, any other technologies you're using in the tibial?

[Dr. John Rundback] We use a lot of orbital atherectomy, and I think the differentiating point for me, although it doesn't necessarily need to be, is you get these cases where the wire will go and nothing else will go. It actually happens with some regularity, right? Really, really tight lesions. Those are ideal orbital cases. You need to go ahead, you need to make some room so that you can treat them, and we get cases where it just looks like an entire artery is a cast of calcium, and we'll still use orbital. However, that's a trade-off. We know that there are emboli which occur with all devices, but the emboli that occur with intimal calcium and that device are probably substantial.

I'm working separately on a device which is a proximal protection device for tibial interventions, a startup company with Peter Schneider and some others which you'll hear about soon. We've done some first-in-human experiment. It's amazing what you're capturing.

[Dr. Sabeen Dhand]
I'm excited to hear about that.

[Dr. John Rundback]
We take that as the cost of doing business. If you're able to use a different technology, definitely you're going to have a little less emboli, and most of the time it doesn't matter, but the patients that you're talking about where they have single-vessel runoff, diabetes, chronic kidney disease, microcirculatory impairment–

[Dr. Sabeen Dhand]
Puny little outflow vessels. You take one of those out, you're shut down.

[Dr. John Rundback]
Yes. Something you don't even recognize it angiographically. The problem is when you talk about embolization, what most people are thinking of is there's a vessel and now it's cut off, but in the spectrum of embolization, there's a lot more. How many times you see an occluded vessel but beyond it a wound blush after the intervention? The vessel is opened, but you don't see the wound blush quite as much. That's microcirculatory embolic injury. The biggest number that I like to cite as we've researched is this idea of unplanned amputation. What is that?

You opened up the artery and went, "Great, why any amputation? What's this unplanned amputation?" We think that what that is is debris that's gone downstream and affected small vessel bed. We're leaning a little bit more, we use a little bit more laser than we did, and our strategy then is one of two things. Either we have pedal access through and through and we can use bad form.

That's balloon angioplasty deployment with force manipulation, but without the balloon you're able to clamp the laser above and then really guide the 0.9 through no matter how tight it might be because you're pushing and pulling at the same time, or we'll go ahead and we'll take a 1.5 millimeter low profile mini track balloon or something like that. Create enough space, usually that'll go down and then we can go ahead and laze and disrupt that medial calcium. Just another consideration of those patients with really impaired runoff.

[Dr. Sabeen Dhand]
This is really good work you're doing. We're lucky to have people in our field to be able to do this type of research and this type of micro look at things is pretty amazing. That's probably the reason why I went into endovascular, IR. Technology just keeps on going. It's just constantly and constantly changing. Thank you for all the work that you've been doing. Any other take home points about the study or future developments that you have?

[Dr. John Rundback]
To the comment you just made, I like the idea of thinking big and thinking small at the same time. Maybe I'm lucky enough that I work with enough companies to be in a position to try to dig a little bit deeper, but I think that's true of anybody. Anybody who's out there who's using these devices and wants to really understand what's going on and wants to do some work, they can generally reach out to the companies and work on a plan to better understand the mechanism of action with an eye to how this will change their clinical use of the device.

IRs are some of the smartest people I know. It's really uniformly a remarkable group of individuals, I've found, for 30 years now, not only that, but a really inquisitive group. We always want to know a little bit more. We're in an ideal position, have always been, to think about these technologies, potentially do the work necessary to improve them or understand them better or to make a difference for our patients.

[Dr. Sabeen Dhand]
Kudos to AngioDynamics for allowing you to look into their device a little bit more post-market release and look at this, and be open to either finding positive or negative results. Obviously this looks very positive, so that's exciting and good for AngioDynamics. Well, John, thank you again for coming onto the show. I really learned a lot and I hope I can convince my group to buy a micro-CT scanner by Nikon. Joking, but no, I continue to look forward to more advancement that you are doing and all the others in the field, so thanks for coming back on the show.

[Dr. John Rundback]
For the podcast listeners, if you have any ideas, call into BackTable, share them, they'll pass it along to me or call me directly, together we can make a difference.

Podcast Contributors

Dr. John Rundback

Dr. John Rundback is a practicing Vascular Interventional Radiologist at AIVS LLP in the New York City area.

Dr. Sabeen Dhand

Dr. Sabeen Dhand is a practicing interventional radiologist with PIH Health in Los Angeles.

Cite This Podcast

BackTable, LLC (Producer). (2023, August 7). Ep. 353 – MicroCT for PAD: What You Need to Know [Audio podcast]. Retrieved from https://www.backtable.com

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.