ABSTRACT We describe the case of a patient with multiple comorbidities scheduled to undergo intracoronary optical coherence tomography-guided percutaneous coronary intervention. Based on the images acquired, it was possible to observe the mechanism of restenosis and the anatomy of the lesion, and to optimize planning of the procedure. Our strategy was to resect the neointimal hyperplastic tissue using laser atherectomy, with great results and a successful procedure.