In single-stage hybrid procedure, the PCI is performed immediately after surgical procedure in collaboration with the interventional cardiology team. Angiographic patency and quality of the LIMA to LAD graft are assessed, and then PCI for the non-LAD lesion is performed with either a bare metal stent (BMS) or drug-eluting stent (DES). A 300-mg loading dose of clopidogrel is administered through a nasogastric tube before the PCI procedure.

After the procedure, it is recommended that patients of DES implantation receive dual antiplatelet therapy with aspirin and clopidogrel for at least 1 year.

The indication for single- or two-stage procedure still remain controvertial. In the ACC/AHA guideline for PCI, it is mentioned that hybrid coronary revascularization may be performed in a hybrid suite in one operative setting or as a staged procedure. This guideline also recommends that bypass surgery before PCI is preferred in the staged procedure, because this approach allows the interventional cardiologist to (1) verify the patency of the LIMA to LAD artery graft before attempting PCI of other vessels and (2) minimize the risk of perioperative bleeding that would occur if CABG were performed after PCI. The two-stage procedure was performed in the initial reports of hybrid procedure, and the benefits of this procedure are an avoidance of potentially postoperative breeding caused by longer operation time and administration of antiplatelets as in single-stage approach. However, a single-stage procedure has been performed widespread in many recent reports because of increasing facilities of the integrated hybrid operating rooms. The hybrid operation rooms can minimize the transference of the patients and also anesthesia time. Recent reports of the single-stage procedure described lower bleeding and blood requirements despite continuous use of dual aspirin and clopidogrel. If a hybrid operating room is set, the single-stage hybrid procedure is recommended for the advantages of maximal availability and minimum risk.