Coronary Revascularization following Failed Multiple Percutaneous Coronary Intravascular Stents

Multiple blocked percutaneous coronary intervention (PCI) stents pose a significant challenge while planning coronary artery bypass grafting (CABG). In most cases, a suitable target site for distal graft anastomosis is difficult to obtain. In this technically challenging case report, we discuss a case of a 40-year-old male presenting with recurrent angina due to blocked multiple PCI stents in the left anterior descending (LAD) vessel. He underwent CABG in which, due to the non-availability of a suitable target site in LAD, the previous stents in LAD had to be excised along with intima and bypass grafting performed by implanting long segment vein patch over the endarterectomized LAD and left internal mammary artery anastomosed over the vein patch. The post-operative course was uneventful. The patient was extubated on post-operative day (POD) 1 and shifted out of the intensive care unit on POD3. He was discharged in stable condition on POD5. In cases where CABG needs to be performed following multiple failed PCI stents, the option of stent excision along with CABG is a safe option with good short-term results.