Patient is a 45 years old Malay gentleman who has underlying type 2 diabetes mellitus, hypertension and active smoker, admitted to district hospital for non-ST elevation myocardial infarction (NSTEMI) in July 2023.

Blood investigations showed LDL 1.5mmol/L with creatinine 64umol/L. Echocardiogram showed ejection fraction (EF) of 49% with mild mitral regurgitation.

Coronary angiogram showed normal left main artery with mild disease at left circumflex artery. There were chronic total occlusion (CTO) of mid left anterior descending artery and mid right coronary artery.

Staged PCI to CTO RCA with short AL 1.0 guiding catheter, managed to cross lesion with Fielder XT-A and Corsair Pro XS, predilated lesion with semi-compliance (SC) balloon 1.0 x 5mm t hen SC 2.0 x 15mm. Further prepared lesion with scoring balloon 3.0 x 15mm and decided to DCB 3.0 x 40mm x2, DCB 3.0 x 30mm and DCB 3.0 x 20mm. Final result showed TIMI 3 flow with non-flow limiting dissections.
Staged PCI to CTO LAD with EBU 3.5 guiding catheter, managed to cross lesion with Fielder XT-A and Corsair Pro XS. Predilated lesion with SC 2.0 x 15mm and scoring balloon 2.5 x 15mm. Decided to DCB 2.25 x 40mm and DCB 2.5 x 30mm with good final results.

Lesion preparation is the key in drug coating balloon (DCB)  angioplasty.  DCB reduces incidence of restenosis in DES especially in bifurcation lesions. DCB is the future ideology of leave nothing behind.