Balancing innovation and safety in percutaneous treatment of coronary artery calcification: the evolving role of cutting balloon technology
6 affiliations
- 1Department of Cardiology, CHU Dupuytren
- 2Department of Cardiology, Hôpital de Jolimont, Hélora Network
- 3Department of Cardiology, Hôpital d'Arlon
- 4Department of Cardiology, Centre Hospitalier de Wallonie picarde (CHwapi)
- 5Department of Cardiology, University Hospital Basel
- 6Department of Cardiology, CHU Saint-Étienne
Abstract
Background: Cutting balloon (CB) angioplasty is one of several approaches to lesion preparation in calcified coronary artery disease. Its comparative efficacy, safety, and optimal use remain incompletely defined.
Aims: To critically appraise clinical studies and emerging technical concepts concerning CB angioplasty, with particular attention to evidence strength, patient selection, and safety.
Methods: This narrative review discusses selected randomised trials, observational studies, mechanistic investigations, and emerging reports concerning CB-based lesion preparation.
Findings: Randomised studies have reported improvements in selected acute imaging endpoints, but findings differ across populations and treatment strategies. Observational studies suggest progressive lumen gain during sequential CB inflations; however, these observations do not establish an optimal inflation protocol. Evidence for comparative long-term clinical benefit and rare device-related complications remains limited. Reported procedural cost differences should not be equated with generalisable cost-effectiveness. Inflation above the device's rated burst pressure constitutes off-label use and falls outside the manufacturer's recommended pressure limits. The Index of Device Efficiency (IDE) remains an exploratory metric rather than a validated treatment target.
Conclusion: CB may be considered among complementary calcium-modification options in appropriately selected lesions. Device choice should reflect anatomy, crossability, imaging findings, and patient risk. Current evidence does not justify routine high-pressure iterative CB use beyond device labelling or universal IDE-guided treatment targets.
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BibTeX
@article{chenard2026balancing,
title = {{Balancing innovation and safety in percutaneous treatment of coronary artery calcification: the evolving role of cutting balloon technology}},
author = {Pierre Chenard and Claudiu Ungureanu and Giuseppe Colletti and Adrien Jossart and Daciana Popa and Agostino Spano and Gregor Leibundgut and Marouane Boukhris},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = nov,
doi = {10.3389/fcvm.2026.1968355},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1968355/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Balancing innovation and safety in percutaneous treatment of coronary artery calcification: the evolving role of cutting balloon technology
AU - Pierre Chenard
AU - Claudiu Ungureanu
AU - Giuseppe Colletti
AU - Adrien Jossart
AU - Daciana Popa
AU - Agostino Spano
AU - Gregor Leibundgut
AU - Marouane Boukhris
PY - 2026
DA - 2026/11/05
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1968355
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1968355/full
AB - Background: Cutting balloon (CB) angioplasty is one of several approaches to lesion preparation in calcified coronary artery disease. Its comparative efficacy, safety, and optimal use remain incompletely defined. Aims: To critically appraise clinical studies and emerging technical concepts concerning CB angioplasty, with particular attention to evidence strength, patient selection, and safety. Methods: This narrative review discusses selected randomised trials, observational studies, mechanistic investigations, and emerging reports concerning CB-based lesion preparation. Findings: Randomised studies have reported improvements in selected acute imaging endpoints, but findings differ across populations and treatment strategies. Observational studies suggest progressive lumen gain during sequential CB inflations; however, these observations do not establish an optimal inflation protocol. Evidence for comparative long-term clinical benefit and rare device-related complications remains limited. Reported procedural cost differences should not be equated with generalisable cost-effectiveness. Inflation above the device's rated burst pressure constitutes off-label use and falls outside the manufacturer's recommended pressure limits. The Index of Device Efficiency (IDE) remains an exploratory metric rather than a validated treatment target. Conclusion: CB may be considered among complementary calcium-modification options in appropriately selected lesions. Device choice should reflect anatomy, crossability, imaging findings, and patient risk. Current evidence does not justify routine high-pressure iterative CB use beyond device labelling or universal IDE-guided treatment targets.
SN - 2297-055X
ER -