Serration Technology Applied to Angioplasty
Peter Schneider, MD
University of California San Francisco
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Hi, I’m Peter Schneider, co-founder of Cagent Vascular and a vascular surgeon at the University of California, San Francisco.
Of all the things we do as vascular specialists, amputation prevention is among the most important—to both our patients and society. Below-the-knee (BTK) disease is the primary challenge we manage every day.
BTK arteries have become a major focus in limb salvage. Across vascular practices worldwide, chronic limb-threatening ischemia (CLTI) is playing an increasingly dominant and serious role in the patients we treat.
Yet, the primary technology we still rely on today is balloon angioplasty—a technique developed more than 60 years ago. While it has served us well due to its simplicity and ease of use, it comes with important limitations.
It doesn’t always create the lumen we need, and it doesn’t always deliver optimal outcomes for patients. We see this reflected in the poor long-term patency data associated with plain balloon angioplasty.
This makes BTK intervention an area where new technologies can have an outsized impact. If we can improve outcomes here, the value is immense—it means saving limbs and preserving quality of life.
The concept behind serration angioplasty is simple: make angioplasty better than it has ever been.
If you think about serrations in everyday life—like those in a checkbook, a notepad, or a box—they exist to direct energy along a specific line so that it can be used efficiently, rather than being dispersed randomly.
The same principle applies here. Instead of distributing force randomly across the vessel wall, serration technology focuses energy along precise, controlled points.
This creates a fundamentally different mechanism of action compared to traditional balloon angioplasty. In a microscopic, localized environment, serration technology can generate up to 1,000 times the force of a plain balloon—but in a highly controlled and directed manner.
The key is not just delivering force, but delivering it precisely. These localized points create a symmetrical stress-relief plane within the vessel.
Once that plane is established, the energy from balloon expansion is guided along it, allowing the artery to expand in a more controlled and optimal way.
Even in complex, heterogeneous lesions—with varying levels of calcium, plaque, and irregular structure—this approach enables more predictable and effective vessel expansion.
The best way to open these lesions is by creating that symmetrical stress-relief plane, and point-force technology is what makes it possible.
It’s a relatively simple innovation, but one that has the potential to produce dramatically different outcomes.
In studies such as the PRELUDE BTK trial, we’ve seen exceptional lumen gain and lower residual stenosis compared to other technologies.
While this is still a balloon-based therapy, it has been fundamentally modified to enable serration angioplasty using point-force technology. Ultimately, it’s the creation of that stress-relief plane that allows the balloon’s energy to be directed in a more effective and meaningful way.
