RT Journal Article SR Electronic T1 Successful angioplasty of saphenous venous graft in-stent restenosis using rotational atherectomy JF BMJ Case Reports JO BMJ Case Reports FD BMJ Publishing Group Ltd SP e230907 DO 10.1136/bcr-2019-230907 VO 12 IS 10 A1 Udaya Prashant Ponangi A1 Sugeet Baveja YR 2019 UL http://casereports.bmj.com/content/12/10/e230907.abstract 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.