A patient with prior extensive stenting of the LAD and the circumflex presented with occlusive in-stent restenosis of the LAD (approximately 100 mm occlusion). A CrossBoss catheter successfully crossed the LAD CTO using the fast spin technique, but flow was not restored with balloon angioplasty. After inflation of additional larger balloons and a cutting balloon in the proximal LAD, antegrade flow was restored. To reduce the risk of restenosis and reocclusion a 4x80 mm peripheral drug-coated balloon was delivered over a GrandSlam wireand inflated in the LAD with a nice final result.

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