This is a 61 years old man who had past medial history as CAD with AMI s/p emergent CAB-G surgery in 2005 with graft 1st vessel to LAD and graft 2nd vein vessel to LCX-OM1 and RCA-PDA. This time, he suffered from suddenly onset chest pain , and visited to our ER where inferior wall STEMI was noted by ECG. Emergent CAG was arranged showed the  2nd vein graft for RCA-PDA part with stenosis and thrombus formation. With failed imrop9ved symtpoms by graft tretmetn,We decide to open the native RCA
1_RCA RAO.AVI
2_RCA LAO.AVI
3.AVI

  Initially we tried to manage the vein graft as aspiration technique and IC Aggrastat injection and balloon dilation. However, the result was not ideal even the flow was appeared. After several trying to improved the vein graft flow but in failed. Patient's angina was still persisted. So we decided to open the native RCA (as chronic total occlusion) that time!

11 20 BC.AVI
15_ante.AVI
18 micro not cross.AVI

 We had tried retrograde and antegrade procedure for the RCA CTO and finally we successful make revascularization of RCA. After stenting, the RCA was coming back as new one It's brave to make the decision to manage the native CTO vessel instead of keeping thrombotic agent injection for the distal vein graft thrombus problems. And fortunately, we overcame the problems and succeed rescue the native CTO vessel for STEMI problems
32 RCAp.AVI
34 ivus.AVI
35 f.AVI

Initially we tried to manage the vein graft as aspiration technique and IC Aggrastat injection and balloon dilation. However, the result was not ideal even the flow was appeared. After several trying to improved the vein graft flow but in failed. Patient's angina was still persisted. So we decided to open the native RCA (as chronic total occlusion) that time!   We had tried retrograde and antegrade procedure for the RCA CTO and finally we successful make revascularization of RCA. After stenting, the RCA was coming back as new one.   It's brave to make the decision to manage the native CTO vessel instead of keeping thrombotic agent injection for the distal vein graft thrombus problems. And fortunately, we overcame the problems and succeed rescue the native CTO vessel for STEMI problems.
1_RCA RAO.AVI
8 gsv2.AVI
35 f.AVI

 It's brave to make the decision to manage the native CTO vessel instead of keeping thrombotic agent injection for the distal vein graft thrombus problems. And fortunately, we overcame the problems and succeed rescue the native CTO vessel for STEMI problems.