

Episode # 57 • 20 Oct 2026
Specialty Balloons in Interventional Cardiology
with Dr. Ziad Ali, Dr. Nyal Borges
Drug-coated balloons and a head-to-head trial against lithotripsy have put cutting and scoring balloons back at the center of complex percutaneous coronary intervention (PCI). On this episode of BackTable Cardiology, Dr. Nyal Borges interviews Dr. Ziad Ali, director of the DeMatteis Cardiovascular Institute, for an in-depth look at the mechanics, selection, and technique behind cutting and scoring balloons in complex PCI. They cover how these devices create a controlled dissection in fibrolipidic plaque, why they only fracture calcium that sits right at the lumen, and how lesion type and imaging should guide the choice between a conventional balloon, a specialty balloon and intravascular lithotripsy.
Timestamps
00:00 - Introduction
02:30 - Mechanism of Cutting and Scoring Balloons
06:13 - Superficial Calcium and Balloon Undersizing
08:39 - Focal Force and Calcium Fracture
11:35 - Device Selection and Lesion Length
15:46 - In-Stent Restenosis, Drug-Coated Balloons and Ostial Lesions
19:52 - Procedural Sequence and Balloon Sizing
24:18 - Sizing Without Imaging and Multiple Inflations
26:43 - Enhanced Stent Visualization as a Procedural Endpoint
29:29 - Complications and Branch Vessel Safety
33:14 - Hematoma Fenestration in Dissection and SCAD
37:30 - Take-Home Points and Closing Remarks
Resources
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More about this episode
Dr. Ali shares why he deliberately undersizes balloons for calcified lesions so the blades, not the balloon, do the work, and why a specialty balloon should be the first device for in-stent restenosis. The conversation covers patient and lesion selection, procedural sequence, imaging strategies, and practical safety pearls. They discuss how to size and position the balloon, when to avoid branch vessels, and why enhanced stent visualization, not angiographic appearance alone, tells you when the lesion is prepared. The episode closes with Dr. Ali’s take-home advice: do not fear specialty balloons, match your strategy to your goal, and use imaging to tailor your approach to each patient.
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