PMC6250038_01
(a) Coronary angiography of saphenous vein graft. (b) OCT finding at the lesion. (c) IVUS finding at the lesion.
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Regarding the bypass graft, the LITA-LAD was patent but the SVG had significant stenosis at the proximal site (Figure 1(a)). The OCT findings also suggested a red thrombus with attenuation (Figure 1(b)). As protruding calcification was detected by IVUS (Figure 1(c)), the lesion was judged as not the red thrombus but the nodular calcification.
(a) OCT findings before rotablator. (b) OCT findings after ablation with 1.75 mm rotablator burr. (c) OCT findings after ablation with 2.0 mm rotablator burr.
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Rotational atherectomy was considered for the treatment of this focal and protruding calcified lesion, although the use of a rotablator for a diffuse degenerative SVG lesion is basically contraindicated.  Figure 2(a) shows the OCT findings preablation, and Figures 2(b) and 2(c) show the postablation OCT findings using 1.75 and 2 mm rotablator burrs, respectively.
OCT findings after stenting.
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A well-apposed and expanded stent was confirmed based on the poststenting OCT findings (Figure 3).
Final coronary angiography.
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The nodular calcification in the SVG was successfully treated by PCI without any complications (Figure 4).