Conventional balloon angioplasty restores coronary blood flow at the expense of some degree of arterial wall injury. The occurrence and degree of vessel wall injury is unpredictable and, in a proportion of cases, results in the complications associated with conventional percutaneous transluminal coronary angioplasty (PTCA). Cutting balloon technology has evolved over nearly a decade. Although initially approved by the U.S. Food and Drug Administration (FDA) in 2000, the cutting balloon has had a rather modest rate of incorporation into interventional practice in the United States. Nonetheless, the cutting balloon may be useful in certain lesion subsets that respond poorly to conventional PTCA and are also not ideal for stenting.