Acute stent thrombosis is a rare, life-threatening, and challenging complication of left main stenting. Equally challenging is treating a chronic saphenous vein graft occlusion. Though considered class III indication per ACC/AHA guidelines, the saphenous vein graft may be the only potential conduit for revascularization. Coronary perforation during chronic total occlusion revascularization after coronary artery bypass grafting is not rare but the post-coronary artery bypass grafting state itself may provide some protection against tamponade by virtue of the adhesions between pericardium and epicardium consequent to surgery. We present a case of multiple complications in one patient and a good outcome after treating each of the above complications.