There is always hope after PCI and stenting.

Nowadays the introduction of intracoronary stents into clinical practice has totally changed the approach to the treatment of diffuse and obstructive coronary artery disease. Although optimal antiaggregant therapy has ensured a low incidence of subacute stent thrombosis, recurrent restenosis remains the major limitation of these intracoronary devices. In such circumstances, surgery may represent the only choice for definitive treatment of recurrent ischemic heart disease. We report an uncommon and challenging way to achieve a complete off-pump coronary revascularization of a seriously diseased, 'full metal jacket' left anterior descending artery (LAD), combining three different techniques at the same time: stent removal, endarterectomy and coronary artery bypass graft (CABG).