1. PCI from native vessel disease or bypass vessel disease post CABG Nanjing first hospital Yefei Chenshaoliang

2. CLINICAL INFORMATION * 83yrs old, male cheif compliant: chest pain for over 9 yrs, and aggravated for 6 mons risk factors: EH, EL, DM2 echo: EF 45%, LV 55mm history: CABG 9 yrs ago, SVG-LCX and D1, SVG-RCA-PD, LIMA-LAD

3. CAG RESULT - LCA

4. CAG RESULT - RCA

5. CAG RESULT - BYPASS VESSELs

6. CAG RESULT - LIMA

7. STRATEGY FOR THE CASE? * From the CAG result, SVG-LCX is acceptable, also as to SVG-RCA and LIMA-LAD, native vessel segment after bypass were not good enough for perfusion, so what should we do next? * PCI FOR THE CASE? * RE-CABG FOR THE CASE? * IF SELECT PCI, WHICH IS BEST CHOICE------ NATIVE VESSELs OR BYPASS VESSELs?

8. OUR CHOICE GC: 7FJL4, Wire: conquest pro Other device: micro catheter

9. Change the conquest wire to BMW wire using microcatheter

10. STENTING LAD 3.0*33mm firebird2 *2 and 3.5*33mm firebird2 *1

11. PCI FOR RCA Miracle 6 cross the CTO lesion with comfiring by intra micro catheter injection of contrast

12. Change the miracle wire to BMW wire using micro catheter

13. Stenting from PD to RCAost with 3.0*33mm firebird2 and 3.5*33mm firebird2*2

14. Cross the wire to PL with XT100

15. Culotte technique for PL-PD bif. With final kissing

16. last result

17. summary for the case It is very difficult sometimes for us to select strategy to treat pts post CABG, native vessels or bypass vessels? We can not get good long-term result even though we had used DES for SVG, and "slow flow" ratio is very high during PCI for SVG even though we had used DPD, How about re-CABG and how difficult we treat native vessel disease after many years of CABG? But, we can!

18. thanks for your attention