The authors present surgical possibilities of treatment of diffuse atherosclerotic changes of the left anterior descending coronary artery. In such serious disease they choose the procedure of endarterectomy performed from long arteriotomy under direct eye control followed by reconstruction by long bypass anastomosis. Endarterectomy of the left anterior descending artery was performed in 32 patients during the period between 1988-1996. This represents 1.38% of patients operated for ischemic heart disease during that period (32/2324). Two patients died in consequence with the operation (6.25%), also there was one myocardial infarction as a perioperative complication (3.1%). Endarterectomy of the diffusely diseased left anterior descending coronary artery can, when carefully indicated and using proper technique, contribute to complete revascularization in patients with end-stage coronary artery disease.