An 7 Fr sheath was inserted into the right femoral artery, and the left coronary ostium was engaged with an 7 Fr JL 4 catheter with side hole. First, 0.014-inch BMW wire was introduced into the LAD, and then the diagonal branch was wired with 0.014-inch Fielder FC wire for protection (Figure 1). On the basis of the IVUS finding, which showed the relatively spared diagonal ostium, the provisional stenting was planned for this lesion. Without predilation, 3.5 x 26mm Orsiro stent was implanted for the proximal one of the tandem lesion, which looked tighter than the distal one on angiography (Figure 2, Movie 3). For evaluation of the hemodynamic significance of the distal lesion, the pressure wire was introduced beyond it, FFR measuring 0.76. Based on the FFR value, another 3.0 x 22mm Orsiro stent was put into the distal lesion, overlapping the proximal stent (Figure 3, Movie 4). The Final angiogram showed near TIMI 3 flow through the diagonal branch, despite the angiographicaly compromised ostium of it ( Movie 5, Movie 6).
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