Intracoronary stents appear promising for treatment of focal vein graft lesions, but their use may be limited by the presence of intraluminal thrombus. This report describes the use of percutaneous coronary angioscopy to identify the presence or absence of intraluminal thrombus and to guide interventional therapy with transluminal extraction coronary atherectomy (TEC) and stenting in a patient with a complex vein graft stenosis. (C) 1994 Wiley-Liss, Inc.