Occasionally, the hard structure of some coronary plaques require special preparation prior to the definitive treatment.

The cutting balloon, a special balloon with small blades on the body, slightly cuts the plaque structure before stenting. Initially, it had the disadvantage of its profile augmented by the blades, which made insertion more difficult. This profile has now been drastically reduced with the new balloon catheters with spiral guides.

Dr Alfonso Medina designed this system in a non-industrial manner, dilating the plaque with several superimposed guides. The outcome was the same. It is occasionally essential to first cut and remodel the plaque.