Use of laser atherectomy, mechanical thrombectomy, and embolic protection for recanalizing a saphenous vein graft chronic total occlusion

An 80-year-old patient with refractory angina and prior coronary artery bypass graft surgery, was referred for percutaneous coronary intervention (PCI) of a chronically occluded obtuse marginal (OM) artery. PCI of the OM chronic total occlusion (CTO) was attempted using an occluded saphenous vein graft (SVG) as the retrograde conduit. The strategy was aborted due to branch vessel perforation which was rescued by placement of a covered stent across the OM ostium. CTO PCI of the SVG to OM graft was then successfully performed using a novel technique with laser atherectomy, mechanical thrombectomy, and distal occlusion for in-situ embolic protection. The vessel remained patent on repeat angiography at six months.