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Figure 2: Angiography demonstrates a stenotic lesion in the mid right coronary artery, undilatable by standard high-pressure balloon angioplasty (inset, arrowheads). (B) Optical coherence tomography (OCT) cross-sectional (top) and longitudinal (bottom) images acquired before IVL and coregistered to the OCT lens (arrow in A) demonstrate severe near-circumferential calcification (double-headed arrow) in the area of the stenosis. (C) Angiography demonstrates improvement in the area of stenosis after IVL (inset; note the cavitation bubbles generated by IVL [black arrows]). (D) OCT cross-sectional (top) and longitudinal (bottom) images acquired post-IVL and coregistered to the OCT lens (white arrow in C) demonstrate multiple calcium fractures and large acute luminal gain. (E) Angiography demonstrates complete stent expansion with the semicompliant stent balloon (inset) without the need for high-pressure noncompliant balloon inflation. (F) OCT cross-sectional (top) and longitudinal (bottom) images acquired post-stenting and coregistered to the OCT lens (arrow in E) demonstrate further fracture displacement (arrow), with additional increase in the acute area gain (5.17 mm2), resulting in full stent expansion and minimal malapposition.

Foreign-trained doctors now make up one-third of cardiologists in the United States and help make up for the overall shortage of physicians. Pictured here is co-author of this article Mandeep R. Mehra, MBBS, MSc, FRCP, who is an example of the contribution international physicians have made in the U.S. He is medical director of the Brigham and Women’s Hospital Heart and Vascular Center, The William Harvey Distinguished Chair in Advanced Cardiovascular Medicine, and a professor of medicine at Harvard Medical School. He is past-president of both the Heart Failure Society of America and the International Society of Heart and Lung Transplantation.