Intravascular lithotripsy for optimized percutaneous coronary intervention of a 30-year-old saphenous vein graft: a case report.

BACKGROUND: Intravascular lithotripsy (IVL) is approved for native coronary calcium modification, but data in saphenous vein grafts (SVGs) are scarce. CASE SUMMARY: An 87-year-old man with remote coronary artery bypass grafting presented with chest pain and was found to have non-ST-elevation myocardial infarction and new left ventricular dysfunction. Angiography revealed severe multi-vessel disease, with an 80% proximal lesion in a 30-year-old SVG collateralizing multiple territories with new wall motion abnormality. Percutaneous coronary intervention with embolic protection was attempted, but dense circumferential calcification limited balloon expansion. IVL with a 2.5 mm Shockwave balloon delivering 120 pulses allowed intravascular ultrasound passage, successful stent deployment, and satisfactory expansion. DISCUSSION: This case demonstrates successful off-label IVL use in SVG percutaneous coronary intervention, adding to limited reports and highlighting its potential in challenging revascularization.