Case ReportAn extensive cutting effect during retrograde percutaneous coronary intervention of a chronic total occlusion through an old degenerated bypass vein

•Treatment of chronic total occlusion lesions remains a major challenge for interventional cardiology.•In previous coronary artery bypass graft patients, when antegrade native CTO percutaneous coronary intervention is not feasible, a retrograde approach through an occluded bypass conduit could be a treatment option; however this approach carries risk for unique complications, some of which can be serious.•We describe a case of retrograde CTO PCI through an occluded saphenous vein graft complicated by an extensive cutting of the vein conduit.

Treatment of chronic total occlusion (CTO) lesions remains a major challenge for interventional cardiology. In previous coronary artery bypass graft (CABG) patients, when antegrade native CTO percutaneous coronary intervention (PCI) is not feasible, a retrograde approach through an occluded bypass conduit could be a treatment option; however this approach carries risk for unique complications, some of which can be serious. We describe a case of retrograde CTO PCI through an occluded saphenous vein graft (SVG) complicated by an extensive rupture of the vein conduit.