How should I treat a patient with left main disease and a totally occluded left anterior descending artery with a diseased saphenous venous graft?

Abstract

A 60-year-old man with history of coronary bypass surgery in 2000 with three saphenous venous grafts (SVG) to left anterior descending artery (LAD), diagonal and obtuse marginal branches, presented by worsening chest tightness of one month duration. He had a clinical history of hypertension, dyslipidaemia and chronic renal impairment. Physical examination, electrocardiography, laboratory tests, echocardiography and coronary angiography. Significant aorto-ostial stenosis of the SVG to LAD, left main stenosis, chronic total occlusion of LAD from its origin and significant stenosis of the mid portion of left circumflex artery. Percutaneous intervention re-do bypass surgery, dual anti-platelet therapy.