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Objectives We report a case in which a patient who suffered from angina secondary to mediastinal irradiation and have been treated by off-pump coronary artery bypass (OPCAB) in our hospital since 3 years ago.A 34-year-old man presented with angina for 8 years after receiving radiation therapy for Hodgkin’s lymphoma.We retrospectively reviewed all the cases of OPCAB in our hospital and followed-up data for up to 3 years post-operatively.Mediastinal irradiation is probably the cause of significant ostial stenosis of left main coronary and fight coronary artery.OPCAB grafting was performed on this patient 3 years ago.His angina disappeared after operation,and he recovered well during follow-up.Conclusions Patients with malignancies who have received mediastinal irradiation should be carefully followed up and routinely screened for the premature development of coronary artery disease.OPCAB may be an appropriate treatment for coronary artery disease caused by mediastinal irradiation.