A 73-year-old male was admitted to our hospital because he had experienced chest pain in the past 2 days. The electrocardiography(ECG) showed QS wave in ECG leads V1 - V3, and Troponin I elevated to 0.78 ng/mL. The patient had been smoking and had a history of diabetes mellitus for more than 20 years. The results of echocardiography indicated that the patient had mild tricuspid valve insufficiency and left ventricular hypo-diastolic function with an ejection fraction of 56%.

Angiography revealed a Medina 010 bifurcation lesion – the left main is normal; the ostium and proximal stenosis of the left anterior descending artery (LAD) is 90%, mid-segment stenosis 70%, and distal stenosis 80%; the circumflex artery (LCX) is diffusely stenotic, with the most severe stenosis being 85%. A 6-French SPB 3.5 guiding catheter (Asahi Intecc Co., Ltd., Japan) was inserted from the right radial artery. First, we performed the pre-dilatation of LCX with a 2.0 mm × 20 mm balloon and implanted 2.5 mm × 29 mm (Firehawk, MicroPort Inc., China) at the mid segments. Then, we failed to deliver the 2.25 × 24 mm (ExCrossal, JW Medical Systems, China)stent to the distal segment and thus switched to implanting a 2.25 × 13 mm (Firehawk, MicroPort Inc., China) stent. Next, a Sion guide wire (Asahi InteccCo., Ltd., Japan) was successfully introduced into the distal of LAD. This mid-segment of LAD was pre-dilated with the 2.5 mm × 20 mm (Pioneer, MicroPort Inc., China)plain balloon, and implanted 2.75 mm × 19 mm (ExCrossal, JW Medical Systems, China). After that, a cutting balloon (2.75 mm × 15 mm) (Flextome, Boston Scientific Co., USA) was employed to dilate the ostium of LAD. Subsequently, a 2.75mm × 30 mm drug-coated balloon (DCB) (SeQuent Please, B Braun Melsungen AG, Germany) was performed at 6 atm for 35 s to treat this lesion. Finally, a drug-eluting stent (2.75 mm × 24 mm) (ExCrossal, JW Medical Systems, China) was implanted 1-2 mm distally to the ostium of LAD.
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The present findings suggest that DCB combined with provisional DES implantation, which is located in the 1-2 mm distally to the de novo medina 010 main coronary bifurcation lesions, could be an alternative revascularization therapy of choice.