Symptomatic anterior myocardial ischemia as a result of stenosis at the origin of the left internal mammary artery developed in a patient who underwent prior coronary artery bypass grafting using the left internal mammary artery as a conduit. Successful revascularization of the left anterior descending coronary artery was achieved using a reversed saphenous vein bypass graft from the left common carotid artery to the proximal internal mammary artery. This approach provided myocardial revascularization and avoided reoperative median sternotomy.