Debulking in Cardiovascular Interventions and Revascularization Strategies

Professor On Topaz received the MD degree in 1979 from the Sackler School of Medicine, Tel-Aviv University and completed residencies in Internal Medicine and Cardiology at the Beilinson and Meir hospitals, Israel. He is a graduate of 3 clinical and research US fellowships including Cardiovascular Pathology at the University of Minnesota [1983-1984], adult Cardiology at the University of Miami [1986-1989] and Interventional Cardiology at the Medical College of Virginia[1989-1990]. Following this extensive training he became an Assistant Professor at Case Western Reserve University and then at the University of Minnesota. In 1993 he joined the division of cardiology, Medical College of Virginia/Virginia Commonwealth University in Richmond, Virginia with a rank of Associate Professor serving as the director of interventional cardiology of the McGuire Veterans Affairs Medical Center . He was a member of the admissions committee of this school of medicine for 11 years . In 2001 he received the rank of Professor of Medicine and in 2002 received as well as a rank of Professor of Pathology. In 2010 he was nominated the chief of the division of Cardiology of Charles George Veterans Affairs Medical Center in Asheville, North Carolina with a rank of Professor of Medicine at the Duke University School of Medicine. Professor Topaz’s main clinical specialty is percutaneous interventions for complex lesion subsets in challenging coronary and peripheral vascular targets. He specializes in treatment of patients with critical lesions in the presence of depressed LVEF, severe left main disease, old saphenous vein grafts, chronic total occlusions, stent thrombosis and heart transplant allograft disease . He has special interest in revascularization of severe renal artery stenosis and severe subclavian artery occlusions. Professor Topaz is the inventor of several percutaneous revascularization techniques with advanced debulking technology for plaque extraction and thrombus removal. He is also a national and international proctor of FDA approved plaque debulking and thrombectomy devices such as laser and rheolytic thrombectomy. Professor Topaz’s clinical investigations and basic research focus on cardiovascular thrombus including pathology and exploration and development of dedicated revascularization strategies for management of thrombus and its constituents during various phases of coronary and peripheral ischemic syndromes . He has gained global recognition for contribution to the understanding and the treatment of thrombotic lesions in acute ischemic/ thrombotic coronary and peripheral syndromes and authored the chapter on The thrombus containing lesion for several editions of the Textbook of Interventional Cardiology ,edited by Topol and Teirstein and published by Elsevier. Professor Topaz is a world authority on cardiovascular lasers whereby he pioneered the contemporary coronary lasing techniques and introduced the utilization of laser revascularization in acute myocardial infarction. In addition, he developed laser application for treatment of congenital heart conditions such as pulmonic atresia. Professor Topaz conducts basic research on the effects of laser irradiation on cardiac and vascular bio-tissue with special focus on the interaction of laser energy with thrombus and platelets. He discovered the unique phenomena of laser- induced enhancement of thrombolytic agents activity and laser induced suppression of platelet aggregation. Clinically , he investigates the therapeutic outcomes of various cardiovascular lasers. Professor Topaz is a recognized researcher and scholar of cardiovascular pathology and vascular anatomy. In 2010 he discovered in several patients the existence of a previously unknown, peripheral artery which constitutes origin of both inferior phrenic arteries as a vascular trunk from the right renal artery. The importance of this discovery was further emphasized as this vessel supplies unique, also newly discovered trans diaphragmatic cardiac collaterals. Recently, he and colleagues introduced an important paradigm shift in the diagnosis and management of symptomatic chronic mesenteric ischemia with emphasis on the performance of endovascular interventions in the inferior mesenteric artery. Professor Topaz served on special study sections of the NIH and NSF and is a fellow of the American College of Cardiology, the American College of Physicians, the Society for Cardiac Angiography and Interventions, the American Society of Laser Medicine and Surgery, the Society of Vascular Medicine and a member of numerous cardiovascular societies and organizations. Professor Topaz is an invited faculty of leading international conferences in the field of interventional cardiology, whereby he participates as live case operator, lecturer, moderator , discussant and session chairperson . He has lectured, proctored and performed live coronary and peripheral interventions in many countries around the world. Between 1998 and 2005 he served as the North American Editor- in- Chief of the journal Laser in Medical Sciences, the clinical publication of the European Laser Association. He is the recipient of an NIH national research service award, the Winthrop interventional award and several teaching awards. In 2010 the McGuire Veterans Affairs medical center of Virginia Commonwealth University established the “On Topaz MD award”, presented annually to their best interventional cardiology fellow . To date, Professor Topaz has published 137 peer-reviewed articles; the textbook “Lasers in Cardiovascular interventions [Springer, UK, 2016]; the textbook "Cardiovascular Thrombus" [Elsevier, Philadelphia, USA, 2018]; 31 book chapters and a member of 18 peer-reviewed journals.23 book chapters and 56 abstracts. He is a reviewer and editorial board member of 16 peer-reviewed journals and a member of medical advisory boards.

1. The resistant atherosclerotic plaque: pathologic features and their impact on revascularization 2. Treatment of complex lesions: the importance of vessel preparation strategies 3. Complications of PCI in calcified lesions: causes, recognition, management and how to avoid 4. Structural heart interventions in calcified, fibrotic and thrombotic mitral, tricuspid and pulmonary valves 5. Chronic total occlusions: the impact of calcific deposits  on the performance and outcome of percutaneous coronary interventions 6. Usefulness and limitations of the current ACC/AHA and ESC guidelines for debulking of calcified and fibrotic lesions in the coronary and peripheral circulation 7. Contemporary perspectives on the role of vascular and endovascular surgery in the treatment of severe obstructive peripheral arterial/disease 8. The impact of biologic factors, anatomy and mechanical forces on calcification and fibrosis of cardiac and vascular structures 9. Debulking challenging large volume intracardiac and intravascular thrombus with the Angio-Vac percutaneous device 10. Atherectomy debulking of calcified left main coronary lesions-strategies and technologies 11. The "nitinol-constrained" balloon angioplasty [Chocolate] and its clinical applications for patients with severe peripheral atherosclerotic arterial disease 12. Abrasion, grinding, pulverization, vaporization and extraction: debulking options for PCI of calcified coronary lesions 13. Coronary allograft disease in heart transplant recipients: pathology, physiology, diagnosis, management and revascularization options 14. Percutaneous management of challenging resistive targets in interventional pediatric cardiology 15. PCI of hard-rock thrombotic lesions and occlusions 16. PCI of calcified coronary lesions: imaging, tools and outcomes 17. PCI of resistant CTO lesions: the utilization of debulking strategy -a Japanese perspective 18. Perspectives on the role of chelation therapy in the treatment of atherosclerosis: principles of application, clinical results and practical implications 19. Percutaneous cardiac valve replacement of heavily calcified valves 20. Challenges in revascularization of the venous circulation: DVT and venous disorders and the role of deep venous stenting 21. Cardiac MRI: the role of an essential imaging modality in cardiac assessment for surgical debulking 22. Cardiac surgery for constrictive pericarditis 23. Coronary Artery Calcification and Coronary Artery Bypass Grafting 24. The utilization of novel laser based catheter for peripheral arterial atherectomy 25. The history, foundations and development of the debulking strategy 　in interventional cardiology 26. The application and interpretation of fractional flow reserve in heavily calcified coronary arteries 27. Recanalization and debulking in CTO revascularization 28. Debulking strategy in coronary and endovascular interventions-targets and tools 29. Laser debulking of complex and resistant atherosclerotic plaques in acute coronary syndromes 30. Thrombus debulking in revascularization of atherosclerotic chronic total occlusions 31. Debulking strategies in revascularization of diseased saphenous vein bypass grafts 32. Transcatheter aortic valve failure: the impact of calcifications 33. Coronary Plaque Modification and Preparation with Intravascular Lithotripsy 34. Utilization of debulking strategies in endovascular interventions in peripheral arterial disease 35. Debulking "rock hard" coronary lesions- real life experience from a large tertiary medical center 36. Perspectives on the rationale and utilization of embolic protection systems in aortic interventions 37. Complex aortic plaque: clinical manifestations, diagnosis and management strategies 38. Strategies for electronic device lead extraction: the impact of calcified and fibrotic tissues 39. Thrombectomy with the Flow Triever device for treatment of massive and high risk sub-massive acute pulmonary embolism 40. Calcium and PCI 41. The Implications of Chronic Kidney Disease on Coronary Artery Revascularization