A 69-year-old gentleman presented with inferoposterior STEMI Presented with chest pain, no heart failure symptoms 
Primary PCI was activated.LM diffuse disease LAD: mLAD CTO with faint antegrade flow and retrograde from RCALCx: mLCx total occlusion, OM1 severe disease RCA: mRCA ATO Runthrough NS wired to PL under Crosair Pro XSLesion predilated with Ryurei 2.0/15 Xience 3.5/48 deployed at m-dRCA

ECG on admission show STE over inferior and posterior leads with RV involvement  Echo done the following day after PPCI : LVEF 40% by Biplane, Hypokinesia over basal to mid inferior and posterior wall Satisfactory RV systolic function Valves unremarkable
peak CK 4600

stage PCI was arranged 

Stage PCI to RCA with JR4 6Fr GCIVUS: under-expansion of stent, significant plaque distal to stent. Another lesion in pRCA with heavy plaque burden and plaque rupture Lesion prepared with Raiden 4.0/15 and NSE 4.0/13Xience 4.0/8 deployed just distal to old stent Xience 3.5/48 deployed to ostial to mRCAPSHP with Raiden 4.0/15 and Raiden 4.5/10 L system PCI with JL4 7Fr GCPCI to LCxRunthrough wired to OM Lesion predilated with sapphire 2.25/15 and Apollo 3.0/15Xience 2.75/33 deployed at pLCx- OM PSHP with NC Trek Neo 3.5/8 and Apollo 3.0/15  PCI to LAD LAD CTO wired with Fielder XT-A under Corsair Pro XSExchanged back to Runthrough NSSerial dilatation with Sapphire 0.85/10, Sapphire 1.0/15, Sapphire II Pro 1.5/15, Sapphire 2.0/15IVUS: small vessel in dLAD, mLAD bridging, pLAD heavy plaque burden
Consideration for stenting- small vessel size at distal landing, high risk of future ISR- potential positive remodeling in future and stent malapposition - myocardial bridging at mLAD 
Further prepare lesion with Scoreflex 2.5/15, Apollo 3.0/15 DEB to pLAD with Pantera Lux 3.0/25Small dissection in pLAD. TIMI III flow. decided for restudy Coro +/- stenting
Restudy coro after 10 months:LAD: positive remodelling of vessel, TIMI III flow. Dissection healed LCx and RCA: patent stent Plan to continue medical treatment and not for further stenting 

Although the recent REC-CAGEFREE I trial show that drug eluting balloon (DEB) fail to achieve non-inferiority compared with drug eluting stenting (DES) for de novo, non-complex coronary artery disease. DEB still have a role in treating specific condition, such as lesion in small vessels. Our case demonstrate that DEB is useful for CTO lesion with distal vessel negative remodelling. Had a undersized DES been deployed in our case, the risk of stent thrombosis and restenosis will be high.  Our case also demonstrate that minor type B dissection after DEB can be managed conservatively, healing is possible and no stenting is needed if TIMI III flow is preserved.