Objective To determine the histological difference between lesions induced by balloon injury and spontaneously formed plaque and to explore the potential impact on scientific research related to these differences. Methods Using the CNKI, Wanfang, Weipu, PubMed, and Web of Science databases, relevant studies on the coronary artery lesions induced by balloon injury were selected. Pathological images of atherosclerotic plaques in the articles were selected and analyzed for their differences from spontaneously forming atherosclerosis. Results Plaques induced by the balloon injury method can often form severe intimal hyperplasia in a short period of time, Resulting in stenosis of the lumen. The main components of the hyperplastic intima are smooth muscle cells and proteoglycans. Internal elastic plate rupture is common, while fibrosis cap and necrotic cores are rare. Conclusions There are differences in morphology between intimal hyperplasia caused by balloon injury and atherosclerosis. Balloon injury may not be suitable as an atherosclerosis model and for mechanistic research and preclinical evaluation.