PCI of an ostial LCX stenosis, with protection of LAD, using two guiding catheters.

A 65-year-old male patient with unstable angina and history of hypertension, diabetes, and hyperlipidaemia was referred for coronary angiography. On the diagnostic procedure, separate ostia of LAD and LCX were found, with a significant lesion in the middle LAD and a high-grade ostial lesion of LCX, which we considered as culprit. We decided to perform an interventional procedure on both lesions. After positioning a guiding catheter in the LCX ostium, we wanted to protect the LAD, but we could not wire both arteries because of separation between the two ostia. We decided than to engage a second guiding catheter in the LAD ostium and wire the LAD. There were no difficulties in implanting safely a stent in the LCX ostium. After that, we proceeded with a standard intervention on the LAD with stent implantation.