Dr. Lorenzo Azzalini, MD, PhD, MSc, FACC, FSCAI, is the Director of Interventional Cardiology Research and an Associate Professor of Medicine at the University of Washington. Known for his expertise in complex and high-risk percutaneous coronary intervention (PCI), Dr. Azzalini has made significant contributions to the field. He graduated magna cum laude from the University of Padua, Italy, followed by advanced training in Spain and specialized fellowships in Montreal and New York. With over 290 peer-reviewed publications and multiple international awards, Dr. Azzalini is a respected leader in interventional cardiology and serves on the editorial boards of several prominent journals.
Thinking back to when you first finished your fellowship, or even during residency, were there any clinical areas you wish you understood more thoroughly or had more experience in?
I remember clearly, during my fellowship—and this was about ten years ago—there was no emphasis at all on intravascular imaging. I also didn’t receive any specific training in chronic total occlusions (CTOs) within the field of percutaneous coronary intervention (PCI). It’s funny because both of these areas later became central to my career and to interventional cardiology as a whole in the last decade. Intravascular imaging, for example, has recently been elevated to a Class Ia recommendation by the European Society of Cardiology, and there are now numerous trials supporting its use in routine clinical practice. So it's definitely something every fellow should learn during their training.
As for CTO PCI, it’s now my main area of expertise, both clinically and from a research perspective. When performed by experienced practitioners, it has a success rate of over 90%, with a reasonable rate of complications. And in many cases, it makes a significant difference for the patient in terms of quality of life.
You're a very well-published physician. For others earlier in their careers—whether they're still in residency or fellowship—who are interested in research, do you have any tips or suggestions?
Yes, that's a great question, and I'm excited to share my experience. I'll start by explaining how I began. As a trainee, whether a resident or fellow, I’d often come across topics that interested me clinically. To deepen my understanding, I’d do a literature review to solidify my knowledge. Sometimes, during this process, I found questions that hadn’t been answered yet, which led me to design observational studies to explore those areas.
Later, when I developed a passion for CTO PCI, I wanted to understand how certain factors—like specific anatomies, such as post-CABG CTOs, or patient populations, like those with chronic kidney disease—might influence intervention outcomes. I realized the most effective way to pursue this was by building an institutional database of our CTO PCI cases. From there, we began conducting single-center analyses, which eventually expanded into multi-center collaborations. This allowed us to work with a larger sample size and diverse patient and technical variables, adding external validity to our findings.
As a byproduct, I also got to know key figures in the CTO community, which helped broaden my professional network. The next step for me was joining PROGRESS CTO, the largest and most published international multi-center registry of CTO PCI, led by Manos Brilakis. This registry has produced over 140 peer-reviewed articles.
It’s critical to understand that research isn’t done in a silo. You can't stay closed off in a small office without interacting with others. The sooner you start connecting, the more you’ll gain—not just in research, but in your professional network, too. One thing leads to another, and eventually, looking back, you see that it’s all about connecting the dots.
It is important to see this whole journey as a marathon. It’s taken one step at a time, with no real finish line—you just keep going. And you keep going because research is your passion, not because it is a means to an end.
With the understanding that every patient is different, do you have a standard protocol for handling calcified plaque in a reasonably routine PCI case?
This is a very hot topic in our field—everyone asks us about it: the industry, other doctors, and our trainees. For me, the foundation of plaque modification decisions comes from intravascular imaging analysis. By assessing calcification burdens with validated scoring systems—there are some for both OCT and IVUS—we can select the best plaque modification technique.
For example, if the calcium burden is only focal, non-circumferential, maybe just short segments here and there, conventional non-compliant balloons or, at most, scoring or cutting balloons will usually be sufficient. But if the calcification is circumferential, long, or thick, we know we’ll need more advanced tools like atherectomy or intravascular lithotripsy (IVL). The decision-making really relies on what we see in intravascular imaging. We also repeat IVUS or OCT after plaque modification to confirm the effectiveness of the chosen technique. So, continuous feedback from imaging helps guide stenting and stent optimization.
Let’s say the calcium burden does require atherectomy or IVL, and you've successfully used it, followed up with IVUS or OCT. Do you typically go back in with a non-compliant balloon before considering a DCB or a stent?
Yes, absolutely—it’s very important. IVL or atherectomy devices are great for modifying or breaking up the calcium, but to fully expand the vessel, you need to go in with a balloon. In rare cases, if you’ve been too quick with the IVL, for instance—maybe only delivering 20 pulses when you actually needed 60 or even 100—going straight to stenting without further plaque modification could lead to problems. You might end up with an under-expanded stent.
So the first step after atherectomy or IVL is to go in with a non-compliant balloon for proper dilation. You want to see if the balloon expands as expected. Also, you can and should confirm with imaging to make sure those cracks are present. Then you move on to stenting, of course.
Thinking back to that time in your career, about a decade ago, coming out of residency and fellowship—are there any business topics you wish you had a better understanding of?
Quite a few, actually. I’ve only recently started grasping the basic principles. Unfortunately, the business of healthcare is very nuanced and complex; it's only partly about being a physician. During training, we receive very little education on how care processes really work.
For example, it is important to know how to document an outpatient visit to ensure that the physician’s work and patient complexity are fully captured in the note for accurate billing. Or understanding how to document procedure indications in a way that maximizes the chances of insurance approval. And, ideally, every physician should have a basic understanding of the economics behind the procedures we perform and the devices we use. We need to be cost-conscious professionals in a healthcare system where expenses are already extremely high.
So, whether you like it or not, the business side of medicine is essential to understand, at least on a basic level.
Dr. Lorenzo Azzalini, MD, PhD, MSc, FACC, FSCAI, is the Director of Interventional Cardiology Research and an Associate Professor of Medicine at the University of Washington. Known for his expertise in complex and high-risk percutaneous coronary intervention (PCI), Dr. Azzalini has made significant contributions to the field. He graduated magna cum laude from the University of Padua, Italy, followed by advanced training in Spain and specialized fellowships in Montreal and New York. With over 290 peer-reviewed publications and multiple international awards, Dr. Azzalini is a respected leader in interventional cardiology and serves on the editorial boards of several prominent journals.
Thinking back to when you first finished your fellowship, or even during residency, were there any clinical areas you wish you understood more thoroughly or had more experience in?
I remember clearly, during my fellowship—and this was about ten years ago—there was no emphasis at all on intravascular imaging. I also didn’t receive any specific training in chronic total occlusions (CTOs) within the field of percutaneous coronary intervention (PCI). It’s funny because both of these areas later became central to my career and to interventional cardiology as a whole in the last decade. Intravascular imaging, for example, has recently been elevated to a Class Ia recommendation by the European Society of Cardiology, and there are now numerous trials supporting its use in routine clinical practice. So it's definitely something every fellow should learn during their training.
As for CTO PCI, it’s now my main area of expertise, both clinically and from a research perspective. When performed by experienced practitioners, it has a success rate of over 90%, with a reasonable rate of complications. And in many cases, it makes a significant difference for the patient in terms of quality of life.
You're a very well-published physician. For others earlier in their careers—whether they're still in residency or fellowship—who are interested in research, do you have any tips or suggestions?
Yes, that's a great question, and I'm excited to share my experience. I'll start by explaining how I began. As a trainee, whether a resident or fellow, I’d often come across topics that interested me clinically. To deepen my understanding, I’d do a literature review to solidify my knowledge. Sometimes, during this process, I found questions that hadn’t been answered yet, which led me to design observational studies to explore those areas.
Later, when I developed a passion for CTO PCI, I wanted to understand how certain factors—like specific anatomies, such as post-CABG CTOs, or patient populations, like those with chronic kidney disease—might influence intervention outcomes. I realized the most effective way to pursue this was by building an institutional database of our CTO PCI cases. From there, we began conducting single-center analyses, which eventually expanded into multi-center collaborations. This allowed us to work with a larger sample size and diverse patient and technical variables, adding external validity to our findings.
As a byproduct, I also got to know key figures in the CTO community, which helped broaden my professional network. The next step for me was joining PROGRESS CTO, the largest and most published international multi-center registry of CTO PCI, led by Manos Brilakis. This registry has produced over 140 peer-reviewed articles.
It’s critical to understand that research isn’t done in a silo. You can't stay closed off in a small office without interacting with others. The sooner you start connecting, the more you’ll gain—not just in research, but in your professional network, too. One thing leads to another, and eventually, looking back, you see that it’s all about connecting the dots.
It is important to see this whole journey as a marathon. It’s taken one step at a time, with no real finish line—you just keep going. And you keep going because research is your passion, not because it is a means to an end.
With the understanding that every patient is different, do you have a standard protocol for handling calcified plaque in a reasonably routine PCI case?
This is a very hot topic in our field—everyone asks us about it: the industry, other doctors, and our trainees. For me, the foundation of plaque modification decisions comes from intravascular imaging analysis. By assessing calcification burdens with validated scoring systems—there are some for both OCT and IVUS—we can select the best plaque modification technique.
For example, if the calcium burden is only focal, non-circumferential, maybe just short segments here and there, conventional non-compliant balloons or, at most, scoring or cutting balloons will usually be sufficient. But if the calcification is circumferential, long, or thick, we know we’ll need more advanced tools like atherectomy or intravascular lithotripsy (IVL). The decision-making really relies on what we see in intravascular imaging. We also repeat IVUS or OCT after plaque modification to confirm the effectiveness of the chosen technique. So, continuous feedback from imaging helps guide stenting and stent optimization.
Let’s say the calcium burden does require atherectomy or IVL, and you've successfully used it, followed up with IVUS or OCT. Do you typically go back in with a non-compliant balloon before considering a DCB or a stent?
Yes, absolutely—it’s very important. IVL or atherectomy devices are great for modifying or breaking up the calcium, but to fully expand the vessel, you need to go in with a balloon. In rare cases, if you’ve been too quick with the IVL, for instance—maybe only delivering 20 pulses when you actually needed 60 or even 100—going straight to stenting without further plaque modification could lead to problems. You might end up with an under-expanded stent.
So the first step after atherectomy or IVL is to go in with a non-compliant balloon for proper dilation. You want to see if the balloon expands as expected. Also, you can and should confirm with imaging to make sure those cracks are present. Then you move on to stenting, of course.
Thinking back to that time in your career, about a decade ago, coming out of residency and fellowship—are there any business topics you wish you had a better understanding of?
Quite a few, actually. I’ve only recently started grasping the basic principles. Unfortunately, the business of healthcare is very nuanced and complex; it's only partly about being a physician. During training, we receive very little education on how care processes really work.
For example, it is important to know how to document an outpatient visit to ensure that the physician’s work and patient complexity are fully captured in the note for accurate billing. Or understanding how to document procedure indications in a way that maximizes the chances of insurance approval. And, ideally, every physician should have a basic understanding of the economics behind the procedures we perform and the devices we use. We need to be cost-conscious professionals in a healthcare system where expenses are already extremely high.
So, whether you like it or not, the business side of medicine is essential to understand, at least on a basic level.
Dr. Lorenzo Azzalini, MD, PhD, MSc, FACC, FSCAI, is the Director of Interventional Cardiology Research and an Associate Professor of Medicine at the University of Washington. Known for his expertise in complex and high-risk percutaneous coronary intervention (PCI), Dr. Azzalini has made significant contributions to the field. He graduated magna cum laude from the University of Padua, Italy, followed by advanced training in Spain and specialized fellowships in Montreal and New York. With over 290 peer-reviewed publications and multiple international awards, Dr. Azzalini is a respected leader in interventional cardiology and serves on the editorial boards of several prominent journals.
Thinking back to when you first finished your fellowship, or even during residency, were there any clinical areas you wish you understood more thoroughly or had more experience in?
I remember clearly, during my fellowship—and this was about ten years ago—there was no emphasis at all on intravascular imaging. I also didn’t receive any specific training in chronic total occlusions (CTOs) within the field of percutaneous coronary intervention (PCI). It’s funny because both of these areas later became central to my career and to interventional cardiology as a whole in the last decade. Intravascular imaging, for example, has recently been elevated to a Class Ia recommendation by the European Society of Cardiology, and there are now numerous trials supporting its use in routine clinical practice. So it's definitely something every fellow should learn during their training.
As for CTO PCI, it’s now my main area of expertise, both clinically and from a research perspective. When performed by experienced practitioners, it has a success rate of over 90%, with a reasonable rate of complications. And in many cases, it makes a significant difference for the patient in terms of quality of life.
You're a very well-published physician. For others earlier in their careers—whether they're still in residency or fellowship—who are interested in research, do you have any tips or suggestions?
Yes, that's a great question, and I'm excited to share my experience. I'll start by explaining how I began. As a trainee, whether a resident or fellow, I’d often come across topics that interested me clinically. To deepen my understanding, I’d do a literature review to solidify my knowledge. Sometimes, during this process, I found questions that hadn’t been answered yet, which led me to design observational studies to explore those areas.
Later, when I developed a passion for CTO PCI, I wanted to understand how certain factors—like specific anatomies, such as post-CABG CTOs, or patient populations, like those with chronic kidney disease—might influence intervention outcomes. I realized the most effective way to pursue this was by building an institutional database of our CTO PCI cases. From there, we began conducting single-center analyses, which eventually expanded into multi-center collaborations. This allowed us to work with a larger sample size and diverse patient and technical variables, adding external validity to our findings.
As a byproduct, I also got to know key figures in the CTO community, which helped broaden my professional network. The next step for me was joining PROGRESS CTO, the largest and most published international multi-center registry of CTO PCI, led by Manos Brilakis. This registry has produced over 140 peer-reviewed articles.
It’s critical to understand that research isn’t done in a silo. You can't stay closed off in a small office without interacting with others. The sooner you start connecting, the more you’ll gain—not just in research, but in your professional network, too. One thing leads to another, and eventually, looking back, you see that it’s all about connecting the dots.
It is important to see this whole journey as a marathon. It’s taken one step at a time, with no real finish line—you just keep going. And you keep going because research is your passion, not because it is a means to an end.
With the understanding that every patient is different, do you have a standard protocol for handling calcified plaque in a reasonably routine PCI case?
This is a very hot topic in our field—everyone asks us about it: the industry, other doctors, and our trainees. For me, the foundation of plaque modification decisions comes from intravascular imaging analysis. By assessing calcification burdens with validated scoring systems—there are some for both OCT and IVUS—we can select the best plaque modification technique.
For example, if the calcium burden is only focal, non-circumferential, maybe just short segments here and there, conventional non-compliant balloons or, at most, scoring or cutting balloons will usually be sufficient. But if the calcification is circumferential, long, or thick, we know we’ll need more advanced tools like atherectomy or intravascular lithotripsy (IVL). The decision-making really relies on what we see in intravascular imaging. We also repeat IVUS or OCT after plaque modification to confirm the effectiveness of the chosen technique. So, continuous feedback from imaging helps guide stenting and stent optimization.
Let’s say the calcium burden does require atherectomy or IVL, and you've successfully used it, followed up with IVUS or OCT. Do you typically go back in with a non-compliant balloon before considering a DCB or a stent?
Yes, absolutely—it’s very important. IVL or atherectomy devices are great for modifying or breaking up the calcium, but to fully expand the vessel, you need to go in with a balloon. In rare cases, if you’ve been too quick with the IVL, for instance—maybe only delivering 20 pulses when you actually needed 60 or even 100—going straight to stenting without further plaque modification could lead to problems. You might end up with an under-expanded stent.
So the first step after atherectomy or IVL is to go in with a non-compliant balloon for proper dilation. You want to see if the balloon expands as expected. Also, you can and should confirm with imaging to make sure those cracks are present. Then you move on to stenting, of course.
Thinking back to that time in your career, about a decade ago, coming out of residency and fellowship—are there any business topics you wish you had a better understanding of?
Quite a few, actually. I’ve only recently started grasping the basic principles. Unfortunately, the business of healthcare is very nuanced and complex; it's only partly about being a physician. During training, we receive very little education on how care processes really work.
For example, it is important to know how to document an outpatient visit to ensure that the physician’s work and patient complexity are fully captured in the note for accurate billing. Or understanding how to document procedure indications in a way that maximizes the chances of insurance approval. And, ideally, every physician should have a basic understanding of the economics behind the procedures we perform and the devices we use. We need to be cost-conscious professionals in a healthcare system where expenses are already extremely high.
So, whether you like it or not, the business side of medicine is essential to understand, at least on a basic level.
Fun, Insightful Interviews with the
World's Brightest Physicians
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Fun, Insightful Interviews with the
World's Brightest Physicians
Delivered straight to your inbox. Completely free. No spam.
Fun, Insightful Interviews with the
World's Brightest Physicians
Delivered straight to your inbox. Completely free. No spam.
You do a lot of training at the University of Washington, with many fellows coming through the program, including Dr. Jesse Kane, who was a guest on this series. When you think about training other physicians, presenting on stage, and so on, what are some important skills you’ve honed over time that contribute to success in these areas?
There are many things to consider when training people—students, residents, fellows, and advanced fellows alike. The first is self-awareness; it’s important to know your own limitations so you can work on them and address any weaknesses. And I mean this in the context of being a mentor and teacher.
Probably the most crucial skill we need to succeed in medicine and academia is emotional intelligence, as it’s foundational to everything—from teamwork to conflict resolution. I read a lot of books, or rather, I listen to them as audiobooks while commuting, to learn about optimal leadership. I try to apply these concepts in my daily practice.
As mentors, we also need to understand how each trainee learns best. Some are visual learners, others need detailed, rational explanations, and some benefit from sketches or visual aids. Knowing how to reach them individually is key to leaving a positive and lasting impact on our trainees.
You’ve had the opportunity to train in different countries and even on different continents. For younger physicians earlier in their careers who are considering training outside their home country or where they went to medical school, do you have any tips or best practices for evaluating these kinds of opportunities?
I think my journey is a bit unique. The guiding principle of my career has been to move to a specific place to learn and gain what I needed at each stage of my development. For example, after medical school, I saw that clinical residency training in Spain was generally better structured than in Italy, so I moved to Spain for my residency.
Later, as I was finishing my residency and decided to specialize in interventional cardiology, I realized that I’d benefit from training in a country with a strong track record of supporting international fellows and advanced PCI interventions. That’s why I chose Canada. At the time, about ten years ago, Canada had access to bioabsorbable scaffolds, drug-eluting balloons, and other new devices for structural interventions that weren’t available in the U.S. However, things have since shifted, with the U.S. now having a faster approval process for new devices compared to Europe. So, moving to the U.S. has given me firsthand experience in practicing interventional cardiology with the latest technology.
Ultimately, it’s about figuring out where you can acquire the skills you need at any given point and being willing to make sacrifices to get there. So, my advice is to stay flexible, be brave, and go where you can best learn and grow.
Let’s move on to the rapid-fire round of questions: Do you listen to music in the cath lab? If so, are there a few songs that top your playlist?
Yeah, I do. I have a short memory, so I’ll just tell you what I’ve been listening to recently. For example, I like Unstoppable by Sia—it’s very energizing. I also enjoy reggaeton, so Volví by Aventura & Bad Bunny are my favorites. And maybe it’ll surprise you, but I like some Taylor Swift too, like Anti-Hero.
How about movies? I know you’re busy, but if you have some time off and there’s a movie on TV, are there any that make you sit down and watch?
Absolutely. I’m an avid movie watcher, especially when I’m traveling. I travel a lot, so I watch plenty of movies on airplane screens. My all-time favorite, both 30 years ago and now, are Top Gun and Top Gun: Maverick. I don’t usually rewatch movies, but those two are the exception—they’re just so energizing. I also enjoy TV shows like Narcos, Narcos: Mexico, and Breaking Bad.
Thinking back to your mid-20s, just after medical school, is there something you’d whisper in the ear of your younger self?
I’d say, believe in yourself. You have a great future ahead—just follow your gut and intuition. Work hard, and you’ll achieve what you want. And ignore the naysayers.
Are there any events, congresses, or research you’d like to highlight?
The two most important meetings for me each year are TCT and CTO Plus. TCT is probably the biggest congress for interventional cardiology, and CTO Plus is the most relevant one for CTO operators. The late-breaking trials are especially exciting, as they’re the ones most likely to impact our clinical practice.
Over time, I’ve learned that you can’t attend every congress, workshop, and event—you have to prioritize well-being and family. I limit my attendance to a few key international meetings, especially where I think I can make a tangible impact. I also enjoy smaller meetings organized by friends and like-minded peers. These events can sometimes be even more valuable than large congresses with thousands of attendees. In a smaller setting, you can connect meaningfully, have a good time, and make an impact in a more informal way. Life is short, so it’s important to spend it doing things you truly enjoy.
You do a lot of training at the University of Washington, with many fellows coming through the program, including Dr. Jesse Kane, who was a guest on this series. When you think about training other physicians, presenting on stage, and so on, what are some important skills you’ve honed over time that contribute to success in these areas?
There are many things to consider when training people—students, residents, fellows, and advanced fellows alike. The first is self-awareness; it’s important to know your own limitations so you can work on them and address any weaknesses. And I mean this in the context of being a mentor and teacher.
Probably the most crucial skill we need to succeed in medicine and academia is emotional intelligence, as it’s foundational to everything—from teamwork to conflict resolution. I read a lot of books, or rather, I listen to them as audiobooks while commuting, to learn about optimal leadership. I try to apply these concepts in my daily practice.
As mentors, we also need to understand how each trainee learns best. Some are visual learners, others need detailed, rational explanations, and some benefit from sketches or visual aids. Knowing how to reach them individually is key to leaving a positive and lasting impact on our trainees.
You’ve had the opportunity to train in different countries and even on different continents. For younger physicians earlier in their careers who are considering training outside their home country or where they went to medical school, do you have any tips or best practices for evaluating these kinds of opportunities?
I think my journey is a bit unique. The guiding principle of my career has been to move to a specific place to learn and gain what I needed at each stage of my development. For example, after medical school, I saw that clinical residency training in Spain was generally better structured than in Italy, so I moved to Spain for my residency.
Later, as I was finishing my residency and decided to specialize in interventional cardiology, I realized that I’d benefit from training in a country with a strong track record of supporting international fellows and advanced PCI interventions. That’s why I chose Canada. At the time, about ten years ago, Canada had access to bioabsorbable scaffolds, drug-eluting balloons, and other new devices for structural interventions that weren’t available in the U.S. However, things have since shifted, with the U.S. now having a faster approval process for new devices compared to Europe. So, moving to the U.S. has given me firsthand experience in practicing interventional cardiology with the latest technology.
Ultimately, it’s about figuring out where you can acquire the skills you need at any given point and being willing to make sacrifices to get there. So, my advice is to stay flexible, be brave, and go where you can best learn and grow.
Let’s move on to the rapid-fire round of questions: Do you listen to music in the cath lab? If so, are there a few songs that top your playlist?
Yeah, I do. I have a short memory, so I’ll just tell you what I’ve been listening to recently. For example, I like Unstoppable by Sia—it’s very energizing. I also enjoy reggaeton, so Volví by Aventura & Bad Bunny are my favorites. And maybe it’ll surprise you, but I like some Taylor Swift too, like Anti-Hero.
How about movies? I know you’re busy, but if you have some time off and there’s a movie on TV, are there any that make you sit down and watch?
Absolutely. I’m an avid movie watcher, especially when I’m traveling. I travel a lot, so I watch plenty of movies on airplane screens. My all-time favorite, both 30 years ago and now, are Top Gun and Top Gun: Maverick. I don’t usually rewatch movies, but those two are the exception—they’re just so energizing. I also enjoy TV shows like Narcos, Narcos: Mexico, and Breaking Bad.
Thinking back to your mid-20s, just after medical school, is there something you’d whisper in the ear of your younger self?
I’d say, believe in yourself. You have a great future ahead—just follow your gut and intuition. Work hard, and you’ll achieve what you want. And ignore the naysayers.
Are there any events, congresses, or research you’d like to highlight?
The two most important meetings for me each year are TCT and CTO Plus. TCT is probably the biggest congress for interventional cardiology, and CTO Plus is the most relevant one for CTO operators. The late-breaking trials are especially exciting, as they’re the ones most likely to impact our clinical practice.
Over time, I’ve learned that you can’t attend every congress, workshop, and event—you have to prioritize well-being and family. I limit my attendance to a few key international meetings, especially where I think I can make a tangible impact. I also enjoy smaller meetings organized by friends and like-minded peers. These events can sometimes be even more valuable than large congresses with thousands of attendees. In a smaller setting, you can connect meaningfully, have a good time, and make an impact in a more informal way. Life is short, so it’s important to spend it doing things you truly enjoy.
You do a lot of training at the University of Washington, with many fellows coming through the program, including Dr. Jesse Kane, who was a guest on this series. When you think about training other physicians, presenting on stage, and so on, what are some important skills you’ve honed over time that contribute to success in these areas?
There are many things to consider when training people—students, residents, fellows, and advanced fellows alike. The first is self-awareness; it’s important to know your own limitations so you can work on them and address any weaknesses. And I mean this in the context of being a mentor and teacher.
Probably the most crucial skill we need to succeed in medicine and academia is emotional intelligence, as it’s foundational to everything—from teamwork to conflict resolution. I read a lot of books, or rather, I listen to them as audiobooks while commuting, to learn about optimal leadership. I try to apply these concepts in my daily practice.
As mentors, we also need to understand how each trainee learns best. Some are visual learners, others need detailed, rational explanations, and some benefit from sketches or visual aids. Knowing how to reach them individually is key to leaving a positive and lasting impact on our trainees.
You’ve had the opportunity to train in different countries and even on different continents. For younger physicians earlier in their careers who are considering training outside their home country or where they went to medical school, do you have any tips or best practices for evaluating these kinds of opportunities?
I think my journey is a bit unique. The guiding principle of my career has been to move to a specific place to learn and gain what I needed at each stage of my development. For example, after medical school, I saw that clinical residency training in Spain was generally better structured than in Italy, so I moved to Spain for my residency.
Later, as I was finishing my residency and decided to specialize in interventional cardiology, I realized that I’d benefit from training in a country with a strong track record of supporting international fellows and advanced PCI interventions. That’s why I chose Canada. At the time, about ten years ago, Canada had access to bioabsorbable scaffolds, drug-eluting balloons, and other new devices for structural interventions that weren’t available in the U.S. However, things have since shifted, with the U.S. now having a faster approval process for new devices compared to Europe. So, moving to the U.S. has given me firsthand experience in practicing interventional cardiology with the latest technology.
Ultimately, it’s about figuring out where you can acquire the skills you need at any given point and being willing to make sacrifices to get there. So, my advice is to stay flexible, be brave, and go where you can best learn and grow.
Let’s move on to the rapid-fire round of questions: Do you listen to music in the cath lab? If so, are there a few songs that top your playlist?
Yeah, I do. I have a short memory, so I’ll just tell you what I’ve been listening to recently. For example, I like Unstoppable by Sia—it’s very energizing. I also enjoy reggaeton, so Volví by Aventura & Bad Bunny are my favorites. And maybe it’ll surprise you, but I like some Taylor Swift too, like Anti-Hero.
How about movies? I know you’re busy, but if you have some time off and there’s a movie on TV, are there any that make you sit down and watch?
Absolutely. I’m an avid movie watcher, especially when I’m traveling. I travel a lot, so I watch plenty of movies on airplane screens. My all-time favorite, both 30 years ago and now, are Top Gun and Top Gun: Maverick. I don’t usually rewatch movies, but those two are the exception—they’re just so energizing. I also enjoy TV shows like Narcos, Narcos: Mexico, and Breaking Bad.
Thinking back to your mid-20s, just after medical school, is there something you’d whisper in the ear of your younger self?
I’d say, believe in yourself. You have a great future ahead—just follow your gut and intuition. Work hard, and you’ll achieve what you want. And ignore the naysayers.
Are there any events, congresses, or research you’d like to highlight?
The two most important meetings for me each year are TCT and CTO Plus. TCT is probably the biggest congress for interventional cardiology, and CTO Plus is the most relevant one for CTO operators. The late-breaking trials are especially exciting, as they’re the ones most likely to impact our clinical practice.
Over time, I’ve learned that you can’t attend every congress, workshop, and event—you have to prioritize well-being and family. I limit my attendance to a few key international meetings, especially where I think I can make a tangible impact. I also enjoy smaller meetings organized by friends and like-minded peers. These events can sometimes be even more valuable than large congresses with thousands of attendees. In a smaller setting, you can connect meaningfully, have a good time, and make an impact in a more informal way. Life is short, so it’s important to spend it doing things you truly enjoy.
