Scoring Balloon Effects on Coronary Calcified Plaque: A Finite Element Analysis

BACKGROUND: Calcified plaques often adversely affect the clinical outcomes after percutaneous coronary intervention because of insufficient lesion expansion. Various pre-dilation balloons are available; however, the expansion effect of scoring balloons in the calcified plaque is unclear. AIMS: This study aimed to examine the effects of a scoring balloon on plaques compared with a noncompliant balloon. METHODS: Aperta NSE was employed as a scoring balloon. We investigated the maximum and minimum principal stresses calculated in four types of stenosis models using the finite element method. RESULTS: The scoring balloon mainly applied the minimum principal stress in the element part and the maximum principal stress in the balloon part to the plaque. In contrast, the NC balloon mainly applied the minimum principal stress to the balloon and element parts. The maximum principal stress of Aperta NSE was observed at both ends of the plaque shorter than the length of the balloon. As the inner diameter of the plaque increased, the maximum and minimum principal stresses decreased when a balloon with the same size and dilation pressure was used. The minimum principal stress was highest on the edge of the element part in the plaque. CONCLUSIONS: The Aperta NSE balloon can yield a higher stress on the plaque than the NC balloon. The pre-dilation of calcified plaques before DES or DCB implantation using a scoring balloon may lead to adequate dilation.