Benefits of cutting balloon before stenting

The objectives of this study were to prospectively evaluate the safety and feasibility of pretreating the culprit coronary artery lesion with cutting balloon (CB) angioplasty prior to coronary stent implantation.

The CB has shown promise for the treatment of de novo coronary lesions and in-stent restenoses, but has not been prospectively evaluated for use prior to stent implantation.

Patients with significant coronary artery disease requiring stent placement had the culprit lesion pretreated with a CB. Stents were deployed to cover the entire segment pretreated with the CB. Intravascular ultrasound (IVUS) was used to interrogate acute luminal gain following stent implantation and after serial post-deployment inflation pressures ranging from 8 16 atmospheres (atm). Coronary angiograms were also obtained to determine luminal diameter. In-hospital complication rates were noted.

Fifty-one patients were treated with the CB prior to stent implantation. Minimal stent cross-sectional area increased significantly with increasing inflation pressures between 8 and 10 atm (p < 0.0004) and between 10 and 12 atm (p = 0.0049). The minimal stent cross-sectional area achieved, as measured by IVUS, was 7.59 mm2 2.00 mm2 at 8 atm, 8.06 mm2 1.53 mm2 at 10 atm and 8.72 mm2 1.58 mm2 at 12 atm. The final in-stent percent diameter stenosis was lower compared to pre-procedure (5.4% 12.2% versus 64.1% 14.1%, respectively) by quantitative coronary angiography.

The CB can be used prior to stent implantation to attain significant gains in minimal stent cross-sectional areas at relatively low pressures.