63 year-old male with known CAD, CABG x2 (1999) and multiple PCI’s to SVG to RCA and LCx branches presented with CCS Class IV angina and non-STEMI (TnI 1.2U). A Cardiac Cath on June 22, 2020 revealed patent LIMA to LAD, non obstructive LCx branches with patent prior stents and 90% multilayer in-stent restenosis of SVG to distal RCA (underexpanded stent) and LVEF 60%. Patient underwent partially successful intervention of SVG to distal RCA lesion using PTCA and atherotomy with residual 50% stenosis due to underexpanded stent. Patient is now planned for OCT guided PCI of multilayer underexpanded stent restenosis of SVG to distal RCA using rotational atherectomy (stent ablation with RA).