A 60-year old man was admitted with effort chest pain for 1 month. 1 year ago, He underwent PCI at LM to proximal LAD and large OM with Endeavor Resolute in other hospital. 2 weeks ago, He did coronary angiogram and He was referred to our center because of the LCX ostial lesion which is not easy to access with guiding catheter due to protruding previous stent in LM ostium.

1. Right coronary angiogram showed deminutive RCA without significant stenosis( Movie 1)
2. Left coronary angiogram showed tight stenosis at LCX ostium. Previous stent at LM to proximal LAD and OM were patent. But the stent strut in LM was protruded into aorta and proximal part of the protruded stent was bent and twisted.( Movie 2)

Because of the protruded stent strut in LM, we engaged guiding catheter (7Fr JL with 4.0cm curve) into flank of protruded LM stent. A 0.014’’ BMW wire was introduced into LCX across the lesion and 0.014’’ Neo’s soft wire was introduced into LAD.( Movie 3) LM to pLAD was predilated with Black-Hawk balloon(4.0*16mm) up to 10 atm and also LM to pLCX lesion was predilated with Maverick (3.0*20mm) up to 14 atm.(Figure 1, Figure 2, Movie 4) After IVUS exam, we dilated pLCX with Avita NM (3.5*20mm) again and we deployed Cypher stent(3.5*13mm) carefully at dLM to pLCX covering the LCX ostium.(Figure 3) We dilated dLM to pLAD with Avita NM(3.5*20mm) up to 10atm and we performed kissing balloon using stent balloon(3.5*13mm, upto 8 atm) and Avita NM(3.5*20mm upto 8 atm).(Figure 4) Final angiography and IVUS showed well apposed stents without any residual narrowing in LM-pLAD and pLCX. ( Movie 5, Movie 6)