Cardiac allograft vasculopathy (CAV) is a major cause of morbidity and mortality after the first year of heart transplantation. It is characterized by progressive, concentric intimal hyperplasia and has a prevalence approaching 50% within the first 10 years after transplantation (1).

We report a case of a male patient who in 2007 at the age of 30 years underwent a heart transplantation due to dilated cardiomyopathy. Seven years later, during routine coronary angiography he was diagnosed with diffuse CAV. In follow-up angiographies successive progression of CAV was observed, despite modification of medical treatment, and it mandated percutaneous coronary intervention (PCI) with implantation of 3 drug-eluting stents (DES) in the left anterior descending artery, the circumflex coronary artery and the right coronary artery, culminating with a successful PCI with implantation of a further DES in left main coronary artery in 2016. Finally, in April 2017 he underwent a successful cardiac retransplantation.

PCI is a feasible bridging strategy for coronary lesions associated due to CAV (1), which includes unprotected PCI for the left main coronary artery stenosis, however the only definitive treatment for CAV is retransplantation.