A Case of Calcified Nodule in the Saphenous Vein Graft Successfully Treated by Guide Extension Catheter‐Supported Orbital Atherectomy System

The use of debulking devices in saphenous vein graft (SVG) interventions is generally contraindicated due to the risk of vascular injury, making the treatment of heavily calcified lesions challenging. We report the case of a 73-year-old man who developed unstable angina 26 years after coronary artery bypass grafting. Urgent coronary angiography revealed severe calcification and critical stenosis at the SVG-to-left anterior descending artery (LAD) anastomosis. Intravascular ultrasound demonstrated a calcified nodule at the anastomosis and circumferential calcification in the mid-LAD. Balloon angioplasty was attempted but failed due to inadequate lesion dilation. To facilitate lesion modification, an orbital atherectomy system (OAS) was delivered using a guide extension catheter (GEC). Multiple ablations were performed, followed by successful balloon angioplasty and application of a drug-coated balloon. The patient was discharged 3 days later without complications. This case suggests that GEC-supported OAS may be a safe and effective option for treating heavily calcified SVG lesions.