Case of coil dislodgement in saphenous vein graft coil occlusion in retrograde chronic total occlusion percutaneous coronary intervention

We report the case of a 78-year-old male with a history of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) to the saphenous vein graft (SVG) to the obtuse marginal artery (OM). The patient presented with acute coronary syndrome and was referred for tertiary care after coronary angiography revealed in-stent restenosis in a thrombotic SVG, along with chronic total occlusion (CTO) of the left circumflex (LCx) artery. Our initial plan was intervention of SVG to OM due to stent restenosis and thrombosis. During the procedure, a balloon rupture resulted in dissection and hematoma. As a bailout intervention, native LCx with CTO ostial stenting was performed, followed by coil occlusion of the SVG. Complications arose when the coil dislodged and fragmented, leading to embolization of one particle in the descending aorta and the other in the femoral artery. Both fragments were successfully retrieved via snare. This case highlights the complexity of managing SVG-related PCI complications and the importance of careful device handling during coiling procedures. © 2025 Elsevier B.V., All rights reserved.