Percutaneous treatment of chronic total occlusions (CTO) is one of the major challenges in contemporary interventional cardiology. These lesions are identified in 15% to 30% of all patients referred for coronary angiography. Percutaneous coronary intervention (PCI) of CTOs is technically challenging and requires familiarity with advanced interventional techniques as well as specialty equipment. The choice of strategy and materials is based on clinical features and coronary anatomy; the correct choice is essential to improve the success probability. PCI of CTOs is usually performed in stable coronary artery disease. We here report a case of a PCI of an anterior descending CTO grafted by a saphenous vein in an 83-year-old man admitted for acute coronary syndrome complicated by hypotensive pulmonary edema.
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