Percutaneous recanalization of total saphenous vein graft occlusion with excimer laser treatment

Patients presenting with recurrence of anginal symptoms after saphenous vein bypass surgery pose an increasingly frequent challenge.In general,approximately 40%to 50%of saphenous vein graft(SVG)will become diseased or occluded within the first ten years after surgery.[1]Because adverse clinical outcomes,such as high restenosis rates and distal embolization,have been reported,percutaneous coronary intervention(PCI)for SVG is not recommended as a first-line strategy.[2]Distal embolization occurs in 2%–17%of patients despite advances in therapy,including the utilization of embolic protection device(EPD),which may lead to increased mortality at both short follow-up and midterm follow-up.[3]However,these patients often associated with inappropriate anatomic characteristics of native vessel intervention including calcification,tortuosity,abundant plaque burden,and complex chronic total occlusion(CTO)lesions.Moreover,repeat coronary bypass surgery is an option but is technically more demanding and is associated with a higher mortality.Therefore,it can sometimes result in SVG stenosis being the only intervention option.This is why the recanalization of SVG lesions,especially totally occluded lesions,remains one of the most challenging procedures in interventional cardiology.

A new buddy stingray and stick technique for antegrade dissection and re-entry during chronic total occlusion recanalization: a case report

Although the retrograde approach was a promising strategy for chronic total occlusions(CTO)-percutaneous coronary interventions(PCI),[1]with the development of coronary interventional therapy technology and interventional instruments,antegrade dissection and re-entry(ADR)are commonly employed in PCI to open CTO of coronary arteries.