Excimer laser for a highly stenotic saphenous vein graft: evidence of debulking by optical coherence tomography

A 73-year-old woman with a history of coronary artery bypass (saphenous vein graft [SVG] for left anterior descending artery [LAD] and right coronary artery) was admitted for non-ST-elevation acute coronary syndrome. Coronary angiography showed a proximal severe stenosis of the SVG for LAD that was the culprit lesion of the acute coronary syndrome (Figure 1A). Frequency-domain optical coherence tomography (FD-OCT) was performed using a non-occlusive technique and showed a highly fibrous stenosis of the SVG (MLA 0.7 mm2) (Figure 1B-E) that was debulked with excimer laser coronary atherectomy (ELCA) (Figure 1-A’,B’). However, a thrombus occurred at the lesion site immediately ...