Intravascular Lithotripsy-Assisted Percutaneous Coronary Intervention of Vein Graft In-Stent Calcified Restenosis

The patency of saphenous vein grafts is poor compared with native and arterial bypass grafts. Graft failures are often managed with percutaneous coronary intervention (PCI) because of the higher risks of undergoing redo coronary artery bypass graft surgery. In addition, PCI to saphenous vein graft has a high incidence of stent failure but is still sometimes required, especially in refractory angina similar to our case. We demonstrate the safety and feasibility use of intravascular lithotripsy as an adjunct for PCI in severe calcified in-stent restenosis in a vein graft. Our case has also highlighted the importance of intravascular imaging in complex high-risk indicated PCI to achieve the best results.