We report the assessment and management of an 81-year-old patient with a rare stenosis in a 50-month-old polytetrafluoroethylene coronary graft. We concluded that atheromatous plaque was the cause for the stenosis based on the lesion location within the graft and its characteristics by intravascular ultrasound. Differential diagnoses are discussed under consideration of the literature. The lesion was successfully treated using endoluminal stenting.