The majority of patients undergoing coronary bypass surgery have at least one internal thoracic artery used as a conduit. Internal thoracic artery atherosclerosis is a rare but distal anastamotic stenosis or occlusion can occur often early after surgery. Percutaneous coronary intervention is a management option. A patient with a left internal thoracic artery-left anterior descending coronary artery occlusion eight days after implantation, in whom balloon angioplasty resulted in avulsion of the left internal thoracic artery, is presented. Emergency coronary rebypass surgery was life-saving. A review of the pathology and clinical literature suggests that percutaneous coronary intervention may be a risky strategy in this scenario. Other options should be sought or percutaneous coronary intervention should be delayed until full surgical healing of the distal anastomosis surgery, which usually takes at least two months.