Plaque modification using a cutting balloon is more effective for stenting of heavily calcified lesion than other scoring balloons

Cutting balloons (CBs) and other scoring balloons are known to be useful for plaque modification in heavily calcified lesions. There have been some reports of the efficacy of these balloons compared to conventional balloons. However, there have been no reports exploring which balloon is most effective among these three types of balloons. We, therefore, compared these three balloons with respect to effectiveness in plaque modification of calcified lesions. We retrospectively investigated 201 cases using these three balloons from April 2015 to December 2017. Of these cases, 156 with severe calcified lesions that had undergone intravascular ultrasound (IVUS) or optical frequency domain imaging (OFDI) were enrolled. The ratio of severe calcified lesion was higher in the CB group than in the groups of other balloons (p = 0.001), and IVUS and OFDI showed that a CB was more effective in plaque modification than the other balloons. The acute gain (minimum stent diameter minus minimum lumen diameter) and acute cross-sectional area (CSA) gain (minimum stent area minus minimum lumen area) were both larger in the CB group than in the others, and the stent symmetry index (minimum stent diameter/maximum stent diameter) showed that the CB group more closely approximated a perfect circle than the other groups (p = 0.0001, 0.006 and 0.002 for the acute gain, acute CSA gain and the stent symmetry index). Similar results were obtained in cases without rotational atherectomy. These data suggest that CB is more effective for plaque modification in cases of severe calcified lesions than other scoring balloons.