ArticleJACC. Case reports2026
Laser-Assisted OPN Technique for Recalcitrant Multilayer In-Stent Restenosis: A Systematic Approach.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- A review of the pathogenic mechanism and clinical management progress of in-stent calcification restenosis.Frontiers in cardiovascular medicine · 2026Review
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMultilayer in-stent restenosis (ISR) with severe stent underexpansion represents a challenging clinical scenario with limited effective treatment options when conventional interventions fail, despite all our current advances in interventional cardiology. CASE SUMMARY: We present a 65-year-old man with recurrent angina despite multiple prior right coronary artery interventions, including intravascular lithotripsy and drug-eluting stent implantation. Optical coherence tomography revealed triple-layer stent restenosis with severe underexpansion refractory to noncompliant balloon and OPN super-high-pressure balloon dilation. The patient was referred to a specialized center, where contrast-enhanced excimer laser coronary atherectomy (ELCA) combined with OPN balloon angioplasty (L-OPN technique) was performed. Intravascular ultrasound-guided ELCA (1.4-mm catheter, 60 mJ/mm DISCUSSION: This case illustrates the systematic L-OPN approach for treating complex multilayer ISR when conventional methods have failed. Contrast-enhanced ELCA generates rapidly expanding microbubbles creating acoustic pressures that can disrupt calcified and fibrotic tissue surrounding underexpanded stents, facilitating subsequent balloon expansion. Intravascular ultrasound guidance was critical for assessing baseline underexpansion and confirming an adequate final result. TAKE-HOME MESSAGE: When conventional balloon angioplasty and intravascular lithotripsy fail to achieve adequate stent expansion in multilayer ISR, the combination of contrast-enhanced ELCA followed by OPN super-high-pressure balloon (L-OPN technique) guided by intravascular imaging offers a viable therapeutic option.
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