The 'Pre-Crack the Plaque' Technique Using SIS Medical's OPN Balloon
A new case series published in Cardiovascular Revascularization Medicine: Interesting Cases (October 2025) by Dr. Michael S. Connolly and Dr. Allison B. Hall of Memorial University highlights the OPN super high-pressure balloon from SIS Medical AG — a device distributed in Canada by ATES Medical.
The paper describes the "pre-crack the plaque" technique: in tight, heavily calcified coronary stenoses, a small-diameter OPN balloon (1.5–2.5 mm), sized to the lesion lumen, is inflated to very high pressure (35–40 atm) to initiate early calcium fractures and plaque modification. Larger non-compliant balloons are then used to expand those fractures, allowing optimal stent deployment.
Key takeaways from the study: - A safe and effective up-front plaque-modification tool for tight, calcified coronary lesions - Small OPN balloons inflated to 35–40 atm initiate the initial calcium fractures - Best guided by intracoronary imaging (OCT/IVUS), with an acceptable safety profile even when imaging catheters will not initially cross - Technically straightforward and potentially cost-effective versus dedicated calcium-modification devices
Across three cases — involving the left anterior descending, right coronary and obtuse marginal arteries — the technique achieved successful lesion modification and stent expansion under OCT and IVUS guidance. The authors conclude that, when feasible, it appears to be a safe, simple and effective means of modifying tight, reasonably calcified coronary lesions.
The full open-access article is available below.
