A 7F sheath was inserted through right femoral artery, and the right coronary artery was engaged with a 7F AL1 catheter. 0.014-inch 190cm BMW wire was inserted into the distal RCA. We initially treat the lesion with application of full-BVS jacket, but IVUS image after pre-balloon dilatation (using Everest 2.5mm x 20 mm, Figure 1) showed disproportionally large vessel size of RCA ostium which cannot be dealt with the BVS (Figure 2, Figure 3). Therefore, we decided to treat the RCA with hybrid approach, namely, BVS-jacket for the available vessels with DES for the large ostial lesion. A total of three Absorb BVSs were deployed successfully at the distal (3.0 mm x 28mm), mid (3.5 mm x 28mm), and proximal (3.5mm x 28mm) RCA, respectively (Figure 4, Figure 5, Figure 6). Then Xience Alpine stent 4.0 mm x 28mm was deployed at the RCA ostium, subsequently (Figure 7). After high-pressure ballooning using NC TRECK 3.0 mm x 20 mm for the distal part and Empira NC 4.0mm x 15mm for the proximal part, final angiography showed excellent outcome (Figure 8, Movie 5).
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