A 77-year-old woman underwent percutaneous coronary intervention PCI for chronic total occlusion of the left anterior descending artery using a drug-eluting stent DES . Re-stenosis, stent fracture, and aneurysm were found on follow-up coronary angiography CAG , and thus implantation of multiple DESs was required. Surgery was indicated because CAG 48 months after first DES implantation revealed enlargement of the aneurysm with other new lesions. She successfully underwent off-pump coronary artery bypass grafting and resection of the aneurysm.