Percutaneous coronary intervention of chronically occluded saphenous vein grafts using excimer laser atherectomy as an adjuvant therapy

We present two cases with chronic total occlusion of the saphenous vein graft in two patients with a history of previous bypass surgery with unfavorable anatomic features for recanalization of the native coronary artery. In the first case, two dedicated attempts for recanalization of chronic total occlusion of the native artery failed and in the second case there was not an adequate visualization of the native vessel beyond the occlusion point, not even by contralateral injection. Excimer laser atherectomy was used in both cases as an adjuvant therapy during recanalization of the saphenous vein graft in combination with a distal protection device in order to reduce distal embolization. The procedures proved successful after stent implantation in the whole length of the saphenous vein grafts and the patients suffered no remarkable events during hospitalization. - Highlights: • Percutaneous coronary intervention of chronically occluded saphenous vein graft in cases with unfavorable anatomic features of native coronary artery. • Use of excimer laser atherectomy as adjuvant therapy in order to reduce distal debris embolization. • Simultaneous use of distal protection device in combination with laser coronary to increase the safety of the procedure.