Totally Occlusive Diffuse In-stent Restenosis in Saphenous Vein Graft to Right Coronary Artery and Acute Coronary Syndrome

A 78-year-old gentleman presented with Canadian Cardiological Society (CCS) class III angina and had been getting excruciating substernal pain while walking 50 to 100 m on the flat over the last 15 days despite optimal medical therapy. From his past medical history the patient underwent CABG in 1997 (LIMA to LAD and SVG to dominant RCA); in 2006 he had an angioplasty done in his SVG and stents were implanted (no medical data regarding the angioplasty were found). Cardiac enzymes and troponin were negative; a mild increase of creatinine was noted on admission. The echocardiogram revealed severe basal inferior wall hypokinesia with overall reasonably preserved left ventricular and right ventricular systolic function... (excerpt)