Snaring of a coronary artery causing distal atheroma embolization

We report a case of total occlusion of the left anterior descending coronary artery with atheromatous debris after “off-pump” grafting. Atheroma break-off and distal embolization probably occurred from proximal snare occlusion of the target coronary artery, and this was recognized by intraoperative angiography. Alternatives to suture snaring should be considered whenever an atherosclerotic artery is to be grafted without cardiopulmonary bypass.