Percutaneous Coronary Intervention in a Patient with Acute Thrombosis of Saphenous Vein Graft and Patent Native Coronary Artery: Which is the Vessel to Approach?

We describe a case of a patient with a clinical history of coronary artery disease, previously treated by coronary surgery and, one year later, by percutaneous coronary intervention plus stenting for sub-occlusive disease of the saphenous vein graft to first obtuse marginal (OM) branch. The patient, admitted to our emergency room with chest pain, nausea, hypotension and diaphoresis, had elevated blood levels of cardiac troponin T and EKG showed elevation of the ST segment in the in lateral leads, suggesting a diagnosis of ST elevated myocardial infarction (STEMI). Thus, coronary angiography was immediately performed, showing the massive thrombosis of the saphenous vein graft previously treated by stenting and the slight patency of the native vessel. We decided to approach the native vessel instead of clashing to the massive thrombus of the saphenous vein graft, overcoming the actual guidelines indications.