The mechanism of instrument-induced coronary artery dissections (IICDs
) is briefly presented, Depending on the coronary anatomy, three diffe
rent situtaions that may occur are distinguished: (1) major coronary b
ranches between the site of dissection and planned anastomosis; (2) no
important collaterals at the same location; and (3) perforation of th
e coronary artery, Surgical methods applicable to each for the correct
ion of these situations is presented.