Percutaneous coronary intervention (PCI) is the mainstay treatment for symptomatic coronary artery disease (CAD). Balloon angioplasty is part of the PCI, in which a small balloon on a long, thin tube is being used to flatten or compress the plaque against the artery wall. There are different types and sizes of balloons catheter available in the market.

• Compliant and non-compliant balloons are mainly used for lesion preparation and stent expansion optimization
• Cutting and scoring balloons are used for lesion preparation in mild to moderate calcified artery before stent deployment. Sometimes, cutting balloons can also be used together with rotational atherectomy for calcific lesion modification.
• Very high pression balloon (e.g. OPN): The balloon has unique double layer and can withstand high pressure inflation which is particularly useful in a tight stenosis, and underexpanded stent

• Monorail catheter
• Over the wire catheter

• Some of the balloons are available in a low profile to overcome challenging anatomies or lesions.
• Some of these balloons are;
  • Apex push (Boston Scientific): available in 1.5 mm and has more pushability
  • Emerge with Push technology (Boston Scientific): Available in 1.2 and 1.5mm
  • Sapphire Balloon with 1.0 mm (CSI)
  • Sprinter Legend Semicompliant balloon with 1.25 mm (Medtronic)
  • Ryurei PTCA Balloon with 1.00 mm (Terumo)
  • Tazuna (1.25 mm balloon with ultra-low entry profile 0.40 mm) (Terumo)

• Unique twin layer balloon construction – providing highest RBP – 32atm
• Linear compliance curve up to over 40atm

• Wolverine Cutting Balloon
  • With a proprietary atherotome and low pressure balloon design for resistance and calcified lesions
  • Available as Monorail and Over-the-Wire balloon

• Flextome Cutting Balloon
  • Consists of a balloon with three to four microsurgical blades (atherotomes) mounted lengthwise on its outer surface which help expansion of target lesion by severing the elastic and fibrotic continuity of the vessel with tiny incisions.

• Flextome vs Wolverine

• Chocolate XD Balloon
  • The balloon’s proprietary nitinol constraining structure creates “pillows” and “grooves” that are designed to provide predictable, uniform, and atraumatic dilatation

• ACROSS: GRIP
  • Four lines of knobs fixed on a strong balloon surface, 16 knobs in total that help to crack heavily calcified lesions and prevent slippage (watermelon effect)

• GRIP TT
  • With the feature of GRIP, GRIP TT add flexible 4mm slanted tip which facilitates navigation through difficult lesions

• AngioSculpt Balloon
  • Can be used in ISR and complex type-C lesions
  • Designed to drive outward expansion with up to 15–25 times the force of conventional balloons

• Dual balloon catheter is comprised of an outer compliant proximal balloon oriented coaxially
  over an inner semi-compliant angioplasty (distal) balloon. The proximal balloon has a larger
  diameter spherical shape in the proximal segment.
• Indicated for optimization of stent located at aorto-ostial anatomies

• DCBs are designed and created to carry antiproliferative drug such as paclitaxel or sirolimus that is delivered to the vessel wall when inflated, thereby preventing neointimal hyperplasia.
• DCBs are now approved by U.S. Food and Drug Administration (FDA) for the treatment of peripheral artery disease (PAD).
• DCBs also are used outside the U.S. to treat in-stent restenosis due to scar tissue proliferation inside the stents.
• No coronary drug-eluting balloon has been approved in the U.S yet but some of DCB are available and being used in Europe.