Cutting balloons are ideal for which lesion type?

• A. Simple, short lesions less than 15 mm
• B. Long, diffuse calcified lesions
• C. Totally occluded vessels
• D. Lesions in large vessels (>5 mm)

Answer: (A)

Cutting balloons work by scoring the plaque with microblades as the balloon inflates, creating controlled intimal tears that allow the vessel to expand at lower pressures and with less trauma. This targeted, concise modification makes them especially useful for simple, short lesions where a small, precise incisional effect can achieve satisfactory lumen gain without provoking significant dissection or recoil. In long, diffuse calcified disease, the blades would have to work over a lengthy segment and scoring may be incomplete or uneven, reducing efficacy and potentially increasing risk. Totally occluded vessels require crossing the blockage first, which is a separate challenge, and cutting balloons don’t inherently address crossing. In large vessels, the benefit is less pronounced because the lesion length and vessel size may limit the utility of the scoring mechanism. Therefore, the best use is simple, short lesions.