Show Notes
Drug-coated balloons and a head-to-head trial against lithotripsy have put cutting and scoring balloons back at the center of complex percutaneous coronary intervention (PCI). On this episode of BackTable Cardiology, Dr. Nyal Borges interviews Dr. Ziad Ali, director of the DeMatteis Cardiovascular Institute, for an in-depth look at the mechanics, selection, and technique behind cutting and scoring balloons in complex PCI. They cover how these devices create a controlled dissection in fibrolipidic plaque, why they only fracture calcium that sits right at the lumen, and how lesion type and imaging should guide the choice between a conventional balloon, a specialty balloon and intravascular lithotripsy.
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Timestamps
00:00 - Introduction02:30 - Mechanism of Cutting and Scoring Balloons06:13 - Superficial Calcium and Balloon Undersizing08:39 - Focal Force and Calcium Fracture11:35 - Device Selection and Lesion Length15:46 - In-Stent Restenosis, Drug-Coated Balloons and Ostial Lesions19:52 - Procedural Sequence and Balloon Sizing24:18 - Sizing Without Imaging and Multiple Inflations26:43 - Enhanced Stent Visualization as a Procedural Endpoint29:29 - Complications and Branch Vessel Safety33:14 - Hematoma Fenestration in Dissection and SCAD37:30 - Take-Home Points and Closing Remarks
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More about this episode
Dr. Ali shares why he deliberately undersizes balloons for calcified lesions so the blades, not the balloon, do the work, and why a specialty balloon should be the first device for in-stent restenosis. The conversation covers patient and lesion selection, procedural sequence, imaging strategies, and practical safety pearls. They discuss how to size and position the balloon, when to avoid branch vessels, and why enhanced stent visualization, not angiographic appearance alone, tells you when the lesion is prepared. The episode closes with Dr. Ali’s take-home advice: do not fear specialty balloons, match your strategy to your goal, and use imaging to tailor your approach to each patient.
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Resources
Cutting Balloon to Optimize Predilation for Stent Implantation: The COPS Randomized Trial. Catheter Cardiovasc Interv. 2023https://doi.org/10.1002/ccd.30603 PREDICTION: Randomized Trial of Cutting Balloon Versus Conventional Balloon Predilation in Severely Calcified Coronary Lesions (jRCT trial record)https://jrct.mhlw.go.jp/latest-detail/jRCTs052200044 ShortCUT: Randomized Trial of Intravascular Lithotripsy Versus Cutting Balloon in Calcified Coronary Disease (trial record)https://clinicaltrials.gov/study/NCT06089135Intravascular Ultrasound-Derived Calcium Score to Predict Stent Expansion in Severely Calcified Lesions. Circ Cardiovasc Interv. 2021https://doi.org/10.1161/CIRCINTERVENTIONS.120.010296 A New Optical Coherence Tomography-Based Calcium Scoring System to Predict Stent Underexpansion. EuroIntervention. 2018https://doi.org/10.4244/EIJ-D-17-00962 BackTable Cardiology Episode 14. COSIRA II: Refractory Angina Challenges & Treatment Strategies, with Dr. Ziad Alihttps://www.backtable.com/shows/cardiology/podcasts/14/cosira-ii-refractory-angina-challenges-treatment-strategies Dr. Ziad Ali, Catholic Health physician profilehttps://doctors.catholichealthli.org/provider/ziad-anwar-ali/2404986 Dr. Nyal Borges, Atrium Health physician profilehttps://atriumhealth.org/provider-profile/nyal-borges-1790042448
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