Pseudoaneurysm after the rupture of a coronary artery is a rare complication of percutaneous transluminal coronary angioplasty (PTCA). We report a pseudoaneurysm of the left anterior descending artery (LAD) occurring 3 months post-PTCA, that was successfully treated by off-pump coronary artery bypass grafting (CABG) and ligation. An 84-year-old man underwent urgent PTCA for unstable angina. The LAD ruptured during this procedure, but bail-out was successfully performed by balloon catheter inflation. The patient left the hospital symptom-free. Three months later, he was rehospitalized complaining of angina. Coronary angiography revealed a 10-mm diameter pseudoaneurysm at the site of the LAD rupture as well as restenosis of the LAD and high lateral branch at the previous PTCA sites. Surgical treatment was indicated because of the difficulty in delivering a covered stent within the diffusely stenosed LAD. CABG to the distal LAD with the left internal mammary artery and ligation of the LAD pseudoaneurysm were performed. To reduce perioperative morbidity, CABG was performed without cardiopulmonary bypass. The postoperative course was uneventful, and follow-up angiography revealed a patent graft and no pseudoaneurysm. The patient has continued comfortably for 18 months postoperatively. Because off-pump CABG is less invasive than conventional surgery techniques, we believe it to be a valid option during coronary pseudoaneurysm ligation.