PT - JOURNAL ARTICLE AU - Udaya Prashant Ponangi AU - Sugeet Baveja TI - Successful angioplasty of saphenous venous graft in-stent restenosis using rotational atherectomy AID - 10.1136/bcr-2019-230907 DP - 2019 Oct 01 TA - BMJ Case Reports PG - e230907 VI - 12 IP - 10 4099 - http://casereports.bmj.com/content/12/10/e230907.short 4100 - http://casereports.bmj.com/content/12/10/e230907.full SO - BMJ Case Reports2019 Oct 01; 12 AB - 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.