Via right femoral access, a 7F EBU3.5 was used to provide support. The lesion was crossed with a RotaFloppy^R wire. Intravascular ultrasound (IVUS) imaging was attempted; however, the IVUS catheter (Boston Scientific OptiCross 40 MHz 135cm^R) could not cross (Fig. 10.2). Rotational atherectomy was then performed using 1.5 mm burr at 150,000 rpm (Fig. 10.3a; Video 10.3, 10.4). Further atherectomy with a bigger 2 mm burr was carried out (Video 10.5, 10.6). Adequate lesion preparation was finally achieved with successful passage of the IVUS catheter (Figs. 10.4a, b and 10.5a–d). Further predilation was performed with a noncompliant balloon 5.0 × 15 mm at 18 atm (Fig. 10.6a–d). A 5 × 26 mm DES was deployed at the left main to proximal LAD (Fig. 10.7a–c). The stent was postdilated with 5.0 × 15 mm (18 atm) and 5.5 × 12 mm (12 atm) noncompliant balloons. Good angiographic result was achieved as seen in the final angiogram (Fig. 10.8a, b, Video 10.7, 10.8).