First Application of Combined Cutting Balloon and Rotational Atherectomy and Intravascular Lithotripsy in Old Degenerated Saphenous Venous Graft

ABSTRACT Saphenous venous grafts (SVGs) are prone to progressive degeneration, leading to complex calcified lesions, which present a therapeutic challenge during percutaneous coronary interventions (PCI). Calcium modification techniques such as cutting balloons, intravascular lithotripsy (IVL), and rotational atherectomy have been employed in native coronary arteries; however, the use of rotational atherectomy in SVGs is controversial. This case report presents a novel approach where calcium modification techniques were successfully used to treat calcified stenosis in 30 years old SVG. The case demonstrates safe and effective use of rotational atherectomy in an SVG, possibly making it the first documented application of this technique in such a context. The report explores the rationale, procedural details, and potential risks of this approach, supported by a review of the existing literature.