Importance of Plaque Modification Before Coronary Artery Stenting

Lately, the importance of plaque modification prior to stent implantation, particularly the use of cutting and scoring balloons, has been a subject of debate. Pre-treatment or plaque modification before stent implantation is an important step to achieve the best possible result and ensure long term safety and efficacy of percutaneous coronary intervention (PCI). The rationale behind plaque modification is that it may minimise arterial injury and subsequent neointimal proliferation and/or restenosis. Artery scoring before stent implantation gives almost perfect stent apposition with reduced inflation pressure and minimised plaque shifting, it also prevents balloon slippage, alters calcification, increases artery compliance and enhances stent deliverability. Appropriate use of scoring balloons for plaque modification with subsequent stent implantation significantly increases acute and post-procedural results of angioplasty. With bioabsorbable stents and bioresorbable vascular scaffolds, plaque modification will be an essential tool to perform complete ‘vessel repair procedures’.