An ultra low contrast PCI of the LAD was performed using dual puncture with EBU 3.5/7F and JR 3.5/6F catheters via radial and femoral access. Saline was used for engagement, with contrast restricted to microcatheter injections of 1 cc each as a sparing strategy. Antegrade proximal cap puncture with Finecross and Fielder XTA tracked subintimally, and a parallel wire technique with Gaia Next 2 successfully crossed the lesion, confirmed by retrograde injection. Lesion preparation was achieved with a semicompliant balloon (2.5 × 15 mm) from mid to proximal LAD and a cutting balloon (2.75 × 18 mm) from mid to ostium LAD. IVUS pullback revealed a long diffuse lesion with proximal and ostial calcification, showing calcium cracks after preparation. MLA at the ostium LAD was 2.5 mm², distal reference diameter 2.8 mm, and LM diameter 4.5 mm. Stent deployment was guided by multiple wires as anatomical landmarks without contrast. A DES (3.5 × 28 mm) was implanted from distal LM crossover to proximal LAD, followed by POT with a 4.0 × 9 mm NC balloon. A second DES (2.75 × 28 mm) was placed in proximal to mid LAD overlapping the first, with post-dilation using a 3.0 × 15 mm NC balloon. IVUS confirmed well-expanded, well-apposed stents without edge dissection. Final MSA was 12 mm² in LM, 10.8 mm² in ostium LAD, and 6.3 mm² in mid LAD. Final angiography with diluted contrast demonstrated TIMI 3 flow, with total contrast use limited to 12 cc.