Background: A common and technically difficult condition is diffusely diseased left anterior descending (LAD) coronary artery with several severe stenoses. Objective: The aim of the present study was to assess the long-term patency following LAD reconstruction with a left internal mammary artery (LIMA) patch, in patients with substantial proximal, multiple long segments, mid and distal LAD stenosis. Patients and methods: This case series was collected from Menoufia University, Farid Habib, and CardioTech Hospital between January 2012 and January 2022. A total of 100 patients who were presented with multi-vessel disease and proximal with multiple long segments mid to distal significant LAD stenoses were included. Results: The majority (72%) of patients in the study were males, with a mean age of 59.08 (SD 2.06) years. The most prevalent comorbidities were hypertension, dyslipidemia, and diabetes mellitus (84%, 68%, and 54%, respectively). The mean EuroScore II was 1.02 (SD 0.24), and the mean ejection fraction was 49.29 (SD 3.5). Grafts of 5 (8%), 4 (70%), or 3 (22%) were used. At 5-years (N.49, 98%) and 10-years (N.46, 92%), follow-up revealed LIMA to LAD patency in every patient evaluated, but we lost track of 1 (1%) patient at 5-years and 4 (4%) patients at 10-years. Conclusion: Coronary LAD reconstruction with LIMA patch is a good option for patients with diffuse coronary artery disease.