Hybrid coronary revascularization (HCR) is a procedure that combines coronary artery bypass grafting (CABG) using the left internal mammary artery (LIMA) to the left anterior descending (LAD) artery with percutaneous coronary intervention (PCI) for other coronary arteries. This approach requires close collaboration between cardiac surgeons and interventional cardiologists, capitalizing on the advantages of both minimally invasive techniques and durable bypass grafting. Indications for HCR typically include patients with suitable coronary anatomy but who are at high surgical risk, have significant comorbidities, or are expected to have high morbidity with a sternotomy. HCR candidates generally fall into four categories: patients with single-vessel disease (LAD +/− diagonals), those with complex LAD disease who benefit from LIMA bypass and PCI for other vessels, high-risk patients with multivessel disease, and individuals whose clinical prognosis favors HCR. Patient preference is also an important factor in decision-making. Timing strategies for HCR include two-stage operations (CABG followed by PCI or vice versa) or a one-stage procedure involving simultaneous CABG and PCI in a hybrid operating suite. The LIMA-LAD bypass is the cornerstone of the procedure, and several techniques for performing the anastomosis are utilized, including off-pump surgery, minimally invasive direct coronary artery bypass (MIDCAB), and robotic-assisted approaches. Although HCR is widely considered safe and feasible, its adoption remains limited, and available clinical data is relatively sparse. Published studies suggest that HCR is associated with low perioperative mortality and morbidity, as well as rapid recovery. Advances in fully endoscopic techniques, including the use of multiple internal mammary arterial grafts, show promising results. The success of HCR relies on a multidisciplinary approach involving cardiac surgeons, interventional cardiologists, and general cardiologists working as part of a cohesive coronary care team.