(A) A preoperative angiogram showing in-stent restenosis with a diffusely diseased LAD coronary artery. (B) Intraoperative image showing the opening of the coronary artery and the removal of the stent. (C) Operative technique: patch reconstruction and CABG with the LIMA. (D) At 18-month follow-up, an excellent patency (the LAD coronary artery and the graft with the LIMA) was observed. CABG: coronary artery bypass grafting; LAD: left anterior descending; LIMA: left internal mammary artery.