- Relevant clinical history and physical exam:
A 74-year-old man was brought to the outpatients department with ongoing chest pain for several months. His medical history was significant for hypertension, diabetes mellitus, hyperlipidemia, emphysema. He had smoked one pack of cigarette daily for past 30 years. His current medications were oral hypoglycemic drugs, antihypertensive medications and lipid lowering agents. The coronary angiography showed severe stenosis in the dRCA with severe calcification and a diffuse significant stenosis in the pmLAD. He was treated with stent for stenosis of dRCA. (Figure 1)

- Relevant test results prior to catheterization:
The EKG is normal. The cardiac biomarkers are normal.

- Relevant angiography findings:
Previous stenting site of dRCA has a good distal flow. However, the diffuse stenosis of pmLAD is still shown. (Figure 2)

- Procedural step:

Doctor Teirstein punctured the Right femoral artery with an eight Fr sheath. The PCI guide wire (BMW 0.014 190 cm) passed through left anterior descending artery by using left XB 3.5 (8 Fr). He scrutinized lesion of LAD with IVUS. The same size BMW guide wire was advanced into Diagonal and measured ACT (333). ( Movie 1) Then, the angioplasty started with the Dura Star balloon (20 x 2.5 mm) at the pmLAD and Cutting balloon (2.5 x 10 mm) at the Diagonal. The Endeavor Resolute stents (3.0 x 33 mm were successfully deployed at the pmLAD and he used stent balloon (3.0 x 33 mm) two times. ( Movie 2) The Endeavor Resolute stent (3.5 x 12 mm) placed at pLAD to overlap the distal stent. ( Movie 3) After inserting stents, IVUS showed appropriate expansion of stents. (Figure 3) Final angiogram showed a good distal blood flow. ( Movie 4)