Coronary Anastomosis In Stent-Useful to Do When No Other Alternative Is Given?

Background  Many patients being referred for coronary artery bypass grafting have a history of percutaneous coronary intervention (PCI). Case Description  In a patient after multiple PCI of the left anterior descending artery (LAD), repeated in-stent stenosis was diagnosed. The LAD being covered with stents to the periphery, no meaningful anastomosis with stent-free vessel was possible. After thorough discussion with the patient, the referring cardiologist, and our local heart team, an in-stent anastomosis was planned and created, that was found to be angiographically patent 21 months after surgery with the patient free from angina. Conclusion  Without any alternative treatment method given, our approach of in-stent anastomosis confers a good mid-term angiographic result.