An 82-year-old man presented for elective coronary angiography. He had recent onset exertional dyspnoea and nitrate-responsive chest pain. ECG showed left bundle branch block; systolic function was preserved at echocardiography.

The left anterior descending coronary artery (LAD) had significant ostial stenosis with calcification; the left circumflex (LCX) had critical ostial disease of the predominant atrioventricular vessel, with a severe stenosis of an early marginal branch (panel A). Coronary surgery was discussed but the patient elected to have percutaneous intervention.

An 8 French JL 4.0 guide …