A 34-year-old expatriate, whose residency permit had expired, was rushed to the emergency department after experiencing acute chest pain for three hours. He was a smoker but had no other risk factors. His ECG revealed an acute anterior wall myocardial infarction. He was in Killip's Class 1 and was hemodynamically stable. He was immediately taken for primary PCI.

Coronary angiogram was done through the right radial artery using 6F XB 3.5 catheter. Left coronary injection showed occluded LAD from the ostium with minor plaque extension to the left main and ramus intermedius, while the left circumflex ostium was free of stenosis. The Right coronary was normal. The patient needed stenting from the left main to LAD, but due to concerns about the continuation of long-term antiplatelet therapy because of expired residency

 The Runthrough guidewire was used to wire the Left Main coronary to LAD, and the LAD ostium was dilated using a 2.5mmx15mm semi-compliant balloon.  The pre-dialation opened the LAD  without any dissection or thrombus. Subsequently, a 3mmx 6mm wolverine cutting balloon was used at 16 atm to further dilate the LAD ostium. LAD was opened well with no dissection or slow flow. Therefore drug-eluting balloon dilation (DEB) was done from the distal left main to LAD with 3.5x 20mm MagicTouch SCB (sirolimus-coated drug balloon) at 8 atm for 90 minutes. A good final result was obtained.  The patient was kept on tirofiban infusion for 24 hours and was given dual antiplatelets (aspirin, clopidogrel) and high-intensity statin. The patient's echo showed a hypokinetic septum and anterior wall with an ejection fraction of 40%. After three days, the patient was discharged and is currently on six-months follow-up. He is stable and asymptomatic at present.

The use of drug balloons to treat native vessel disease is a new approach, but there isn't enough information about its effectiveness in patients with acute myocardial infarction. The idea is to treat native ostial lesions by combining cutting balloon dilation with a drug-coated balloon (DCB/DEB) to deliver the drug to prevent barotrauma-induced vessel restenosis. The advantage of cutting balloon is that it reduces vessel stretch and injury by scoring the vessel longitudinally, rather than causing an uncontrolled disruption of the plaque. This approach helps to avoid future stent-related events, but it is relatively new and requires further evidence to support its effectiveness.