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Cutting balloons and AngioSculpt® 

Cutting balloons and AngioSculpt®
Chapter:
Cutting balloons and AngioSculpt®
Author(s):

Mike Seddon

and Nick Curzen

DOI:
10.1093/med/9780199569083.003.035
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date: 17 February 2020

Although percutaneous coronary intervention has revolutionized the treatment of coronary artery disease, it has been limited by acute ischaemic complications and restenosis. It is well recognized that elastic recoil, negative remodelling, and neointimal hyperplasia are the underlying mechanisms of restenosis, with a clear association between the extent of vascular injury sustained and subsequent intimal hyperplasia. The search for a method to dilate an obstructive coronary lesion without invoking this proportional injury response led to the development of a variety of devices designed to excise or modify plaque in order to limit intimal injury. In 1991, Barath and colleagues developed a noncompliant cutting balloon with three or four microblades fixed radially to it. It was hypothesized that the discrete longitudinal incisions created during balloon inflation might improve the success of conventional balloon angioplasty by reducing elastic recoil and minimizing intimal injury, thereby minimizing the subsequent neointimal proliferative response. Theoretically, this effect would allow cutting balloon angioplasty to achieve and maintain a larger lumen diameter using lower balloon inflation pressures and durations than conventional balloon angioplasty. Technology has since progressed rapidly through several stages, with the introduction of intracoronary stents, advances in adjunctive antiplatelet therapies, and the advent of drug-eluting stents. However, the Cutting Balloon®, and the recently approved AngioSculpt® scoring balloon, remain in the armamentarium of the interventional cardiologist today. This chapter summarizes the clinical experience with these devices to date and their place in the current era.

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