A 57-year old non-diabetic, normotensive, dyslipidemic gentleman was admitted to our hospital with unstable angina. He was a ex-smoker. Three months ago, he received PCI on the distal main to proximal LAD, and prox to distal LCX with Xience-V stents, 3.5/12mm and 3.0/20mm, respectively. His physical examiniation was normal and cardic enzymes were normal. His ECG and chest X-ray were unremarkable. Echocardiography reveals no gross regional wall motion abnormality with LVEF ~61%.

1) Rt. coronary angiography showed diffuse 30-40% stenosis from proximal to mid part of right coronary arery (RCA). ( Movie 1)
2) Lt. coronary angiography showed very tight stenosis in main ostium. Previous stents were patent. ( Movie 2, Movie 3)

A 7F sheath was inserted through right femoral artery and a 7 F JL4 guiding catheter was engaged in left coronary artery. An 0.014” BMW guidewire was positioned in the LAD. From IVUS exam, It was revealed severely stenotic lesion with an eccentric mixed plaque (Figure 1). We performed a direct stenting with a 4.0/15 mm Xience-V stent at 14atm(4.28) (Figure 2). Because post-pocedural IVUS exam showed good apposition and adequate stent expansion (Figure 3), additional balloon inflation was not done. Final angiogram showed the procedure was successful (Figure 4, Figure 5).