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hi this is Salman Alana and manage burlakis presenting case 158 for the manual of percutaneous coronary interventions this is a case illustrating some of the challenges of percutaneous coronary intervention in degenerated Southerners vein crafts the patient was an elderly gentleman who presented with non-st elevation myocardial infarction Diagnostic in geography shows a significant lesion in the proximal LED however there is a patent Lima there is a circumflex with a moderate proximal lesion and a chronically occluded esophage vein craft going to the obtuse marginal branch then we do have a patent vein graph to the PDA the native RCA was chronically occluded we do have a degenerated shuffling graph to the diagonal with multiple lesions and Timmy 2 and the great flow this is the array of you again so severe eccentric lesions with likely a large amount of plaque and then we do have a patent limit LED with significant tortuosity what to do next the question in SCS patient is about the cul

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