Successful recanalization of chronic total occlusion using retrograde approach in a patient with acute coronary syndrome due to aortosaphenous vein graft occlusion

Although percutaneous coronary intervention (PCI) is one of the most suitable treatment options in patients with acute coronary syndrome (ACS), PCI for ACS patients with occluded saphenous vein graft (SVG) remains challenging. An 80-year-old man with previous coronary artery bypass grafting (CABG) was admitted with the diagnosis of ACS. Emergent coronary angiography showed a total occlusion of SVG to the left circumflex coronary artery (LCx) with large thrombus burden. Because of concern about serious distal embolization, we subsequently performed primary PCI for the occluded native LCx using a combined antegrade and retrograde approach with the SVG as an access conduit. Successful crossing of the native LCx was achieved by retrograde wire through the SVG, and finally recanalization and stent placement was done. A retrograde approach for chronic total occlusion of coronary artery has become more popular during recent years with encouraging results. This novel technique may provide an additional therapeutic option even in ACS patients with previous CABG.