We present the case of a 72-year-old man who underwent off-pump coronary artery bypass grafting of 4 coronary arteries with exclusive use of the left internal mammary artery with a side-branch (mediastinal artery). Before discharge from the hospital, contrast computed tomography angiography confirmed the patency of all 4 coronary grafts. Use of the mediastinal artery side-branch of the internal mammary artery allowed grafting of 4 coronary arteries using only one internal thoracic artery.
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