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A 53 year old man presented with exertional dyspnoea during daily activities. He was a current smoker and had a positive exercise test. Angiography showed a significant left main (LM) stenosis (panel A, white arrow) and a 70% narrowing of the circumflex artery (CX). The left anterior descending (LAD) and right coronary artery were occluded. Left ventricular (LV) function was poor and showed a large calcified anterior wall aneurysm (panel A and panel C, black arrow, end systolic frame). In a hybrid strategy, unprotected LM angioplasty with stenting was successfully performed (panel B, arrow). After three and 12 months, no angiographic restenosis was found. Echocardiographic follow up confirmed improved wall motion. Thereafter, surgical resection of the anterior aneurysm was performed and arterial bypass grafts were anastomosed to the LAD and marginal branch of the CX. At 24 months follow up, LV function was excellent (panel D) and the patient had resumed his work at a local service delivery.