A 69-year-old male was admitted with effort chest pain. His coronary risk factors were hypertension, diabetes, and smoking. His ECG and cardiac biomakers were normal. His exercise ECG test and thallium SPECT showed negative results.

1. A right angiogram showed mild coronary artery disease without significant stenosis.(Figure 1)
2. A left coronary angiogram showed diffuse stenosis from the promixal to the mid LAD with a short segment of stenosis just proximal to the LAD-Dx bifurcation.(Figure 2, Figure 3)

A 7 Fr XB 3.5 with side-hole guiding catheter was engaged into left coronary artery. A FFR wire was located in the distal LAD beyond the bifurcation. Baseline FFR was 0.93 and dropped to 0.79 after adenosine infusion via central vein without step-up during pull back. After retracting the FFR wire, a 0.014” Floppy BMW guidewire was placed into the LAD and then IVUS imaging was performed. The IVUS showed atherosclerotic disease in the prox-to-mid LAD with a relatively plaque free segment(about 10 mm in length) in the proximal LAD where we planned to land stent. The lesion was predilated with a 2.5 * 15 mm noncompiant Dura Star balloon and the first stent, 3.0 * 20 mm Promus Element, was deployed in the middle segment of LAD just beyond the big septal branch.(Figure 4, Figure 5) A 4.0 * 12 mm Promus Element stent was deployed in the proximal segment of LAD without overlapping.(Figure 6) Adjunctive postdilatation were done with a 3.5 * 13 mm Fortis balloon and a 4.0 * 10 mm Dura Star balloon. Final angiogram showed a good result.(Figure 7, Movie 1)