Essential thrombocythemia (ET) is a rare myeloproliferative disorder characterized by pathologic expansion of the megakaryocytic elements in the bone marrow leading to persistent thrombocytosis and platelet dysfunction. The incidence of coronary artery disease can reach 9.4% and this is accompanied by high incidence of acute myocardial infractions. There are no clear guidelines for best management approach to these patients when cardiac surgery is planned. A case of ET required coronary artery bypass graft surgery for stent occlusion is presented with careful preoperative planning leading to full recovery with no complications.