The cutting balloon for in-stent restenosis: a review

Extraordinary advances have been made in the prevention, medical treatment, and the surgical and percutaneous intervention of coronary artery disease. However, despite the vast contribution of coronary artery stenting, coronary artery disease remains a major health problem. The massive treatment of symptomatic coronary artery disease with non-drug-eluting stents in the past, accounts for a large incidence of in-stent restenosis (ISR). We know today that in the following days after coronary artery angioplasty, new layers of intimal cells, called neo-intima, scaffold the endothelium forming a rubbery membrane. Numerous attempts have been made, and are still ongoing, to prevent the formation or to remove the neo-intima with suboptimal results and cost-effectiveness. Drug-eluting stents seem to be the most promising approach to date, however, the high cost of these devices may limit their use. In the mean time, new cases of ISR present to our cardiology practices. Because of its lower cost and identical technique to a regular balloon, the cutting balloon has emerged in numerous observational studies, and in a few randomized studies as a practical alternative to treat ISR. Although a few randomized studies have compared angioplasty with the cutting balloon versus angioplasty with a regular balloon, there are no randomized or economic studies comparing this device to excimer laser or intracoronary radiation in the treatment of this complication of coronary stenting. We reviewed the most prominent studies to date, on the performance of the cutting balloon in the treatment of ISR.