Video 1: If at First You Don't Succeed, Try, Try Again: A Stepwise Approach to the Non-Dilatable Lesion

Video 1. Total occlusion of saphenous vein graft to D2 at its proximal anastomosis status post prior BMS. A 60-year-old male with a history of diabetes mellitus on oral hypoglycemic agents, hyperlipidemia, and known coronary artery disease presented with recurrent angina nearly 12 years after coronary artery bypass surgery. A stress test demonstrated anterolateral ischemia, after which the patient underwent cardiac catheterization at an outside hospital. The saphenous vein bypass graft to the second diagonal branch contained a high-grade proximal stenosis felt to be the culprit lesion. Percutaneous coronary intervention of this vein graft lesion was performed with placement of bare metal stents due to concerns about gastrointestinal bleeding at the time.

Six months after this vein graft stent procedure, the patient developed recurrent unstable anginal symptoms despite an optimized anti-anginal regimen, which prompted repeat cardiac catheterization at our institution. The vein graft to the second diagonal branch was now 100% occluded proximally within the previously placed stents (Video 1).

From "If at First You Don’t Succeed, Try, Try Again: A Stepwise Approach to the Non-Dilatable Lesion"


Antony G. Kaliyadan, MD, Henry Siu, MD, David L. Fischman, MD, Nicholas J. Ruggiero II, MD, Brandon M. Madsen, BS, and Michael P. Savage, MD, Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania