Initial results of cutting balloon angioplasty as analyzed by quantitative coronary arteriography and intravascular ultrasound

In order to evaluate the efficacy of the cutting balloon (CB) for coronary angioplasty, single inflation was performed in 23 lesions (22 patients); a residual stenosis of <50% (success) was achieved in 16 (69.6%) lesions, but additional dilatation was required in 5 with the plain old balloon, in 5 with the CB and 2 patients required stents. In one patient the CB could not cross the stenotic lesion but was adequately dealt with the standard balloon. It is unclear at this point how these additional interventions would affect the ultimate outcome in terms of restenosis. Intravascular ultrasound imaging after CB dilatation in 12 lesions revealed that when wall calcification of the vessel did not reach 50% of the vessel circumference, the resulting vessel wall was smooth and the lumen was circular in shape, but when the calcification extended to > 50% the lumen was oval. These results are indicating the difficulty in obtaining adequate dilatation by a single inflation alone even using the CB, especially in heavily calcified lesions. Perhaps it is related to the necessarily smaller balloon size chosen when using the CB, but seems to underline the crucial importance of the balloon size in obtaining favorable results.