<p id="hl0000053" class="ng-scope"><strong><em>When in doubt, use brute force. </em></strong></p> <p id="hl0000056" class="ng-scope"><strong> <em> -- Ken Thompson </em></strong></p> <section id="hl0000059" class="ng-scope"><a id="s0005"></a> <h2 class="section-label c-content-section__label">1. The clinical need</h2> <p id="hl0000062">Adverse clinical events associated with suboptimal lesion/stent expansion include restenosis and stent thrombosis. The “bigger is better” concept proposed by Rick Kuntz in the 1990s not only applies to lesions after atherectomy but also rings true in bare metal stents and extends to the current drug-eluting stent era as well, in the treatment of coronary artery obstructions. All of us have come across lesions that may “look innocent” on angiography but turn out to be quite recalcitrant to balloon dilatations. In general, the operator usually has procedural, angiographic, or other imaging hints that the target lesion may be resistant to routine balloon dilatation. Further, in difficult-to-dilate lesions, the concept of lesion modification using ablative technologies, including rotational, laser and, more recently...</p> </section>