Cutting balloons versus conventional balloons for treating patients with coronary artery disease presenting with moderate-to-severely calcified lesions: impact on post-interventional minimum stent area

Cutting balloons are commonly used to treat patients with coronary artery disease (CAD) presenting with calcified lesions, but the efficacy of cutting balloons has not been elucidated. We aimed to investigate the impact of novel cutting balloons (Wolverine™) relative to conventional balloons on post-interventional stent expansion for coronary calcified lesions. This study was a single-center, retrospective, observational study. We analyzed 636 lesions from 543 patients with moderate-to-severely calcified CAD lesions undergoing intravascular ultrasound (IVUS)-guided percutaneous coronary intervention using cutting balloons or conventional balloons prior to drug-eluting stent implantation. The primary outcome was post-interventional minimum stent area (MSA) evaluated by IVUS. Propensity score matching was performed to adjust for baseline characteristics. The interaction effects between balloon type and baseline characteristics were also assessed in MSA > 5.5 mm². Data on pairs of lesions (n = 168) were extracted with no major intergroup differences in baseline characteristics. Post-interventional MSA was not significantly different in the two groups (5.3 ± 2.0 mm² versus 5.1 ± 1.9 mm², P = 0.42). Subgroup analysis indicated the subgroup (calcium arc > 180°) showed the qualitative interaction of balloon type effect (P for interaction = 0.056) and the use of cutting balloons was more favorable for lesions with calcium arc ≤ 180° (adjusted odds ratio 4.10, 95% confidence interval 1.14-14.69). The use of cutting balloons did not demonstrate the beneficial effect on post-interventional MSA relative to conventional balloons for patients with CAD presenting moderate-to-severely calcified lesion. However, the use of cutting balloons was more favorable for lesions with calcium arc ≤ 180° to obtain the optimal MSA.