An 81-year-old, functionally independent woman with a history of bypass surgery and a previous vein graft intervention presented to us with significant angina refractory to medical management. An urgent angiogram revealed severe in-stent restenosis (ISR) in the proximal stent of the right coronary artery graft. At the same time, multiple trials to predilate the tight ISR using various-sized non-compliant and cutting balloons were unsuccessful. During the second attempt the next day, rotational atherectomy was used for plaque modification as the lesion appeared fibrocalcific angiographically. A good imaging result was obtained after final dilatation with a drug-eluting balloon, and the patient also achieved immediate angina relief. Even though rotational atherectomy is contraindicated in vein graft interventions, it can be successfully used in selected cases when routine angioplasty techniques fail.
- Interventional cardiology
- Ischaemic heart disease
- Surgical diagnostic tests
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Contributors UPP and SB were involved in planning, performing and follow-up of the procedures in the case study. UPP prepared the manuscript and SB edited the final version.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.