The patient is a 67-year-old male who was admitted to the hospital on 2005/11/22 mainly because of episodes of chest pain during exertion for 15 years, which worsened for 5 days. The episodes of chest pain lasted for about 5-10 minutes when walking fast or walking up stairs, and could be relieved by rest or nitroglycerin, accompanied by panic and chest tightness. He had frequent episodes of unprovoked symptoms for 5 days before admission, and his activity tolerance was reduced. He had a history of hypertension for 4 years, with a maximum blood pressure of 160/80 mmHg, and his blood pressure was controlled in the normal range by insisting on captopril. On admission: blood pressure 150/88 mmHg, good spirit, clear speech, no deformity of the five senses of the head, no anger in the jugular vein, clear breath sounds in both lungs, small heart borders, heart rate 70 beats/min, rhythmical, low and obtuse heart sounds, no murmur heard in each valve auscultation area. There was no swelling of both lower limbs. The electrocardiogram showed: sinus rhythm ⅡⅢaVFV4~V6 leads T-wave was low or inverted, cardiac ultrasound and chest X-ray showed no abnormalities in cardiac structure and function, and laboratory lipid and blood glucose were within normal range. Admission diagnosis: 1. coronary artery disease with exertional angina major, 2. hypertension grade 2 very high risk. He was given isosorbide mononitrate, enteric aspirin, Bolivar, betalactam, captopril orally, low molecular heparin subcutaneously, and nitroglycerin intravenously, and his symptoms were quickly controlled. After preoperative preparation, coronary angiography via the right radial artery was performed on 2005/11/28. Intraoperative findings: when the left coronary angiogram was performed with a 4F multifunctional contrast catheter, the left gyral branch was found to be absent, the left anterior descending branch was smooth without stenosis, and a large diagonal branch emanated from the left anterior descending branch, and a 90% restrictive stenosis was seen in the proximal segment of the diagonal branch. During the right coronary angiography, the catheter first selectively entered the smaller vessels supplying the right anterior ventricular wall (equivalent to the right ventricular branch), and the right coronary artery was faintly visible to the right of the right ventricular branch when the contrast agent was injected, and the catheter was selectively fed into the right coronary artery after adjusting the catheter direction. When the catheter was withdrawn and reoriented, a thicker vessel was faintly visible on the left side of the first two vessels emanating from the right coronary sinus almost vertically, traveling laterally and supplying the left ventricular lateral wall (equivalent to the left gyral branch). Since it was difficult to selectively feed the multifunctional contrast catheter into the opening of the vessel supplying the left ventricular collateral wall, the AmplatzAL1 contrast catheter was replaced and the angiogram of the vessel supplying the left ventricular collateral wall was selectively performed, which showed 90% restrictive stenosis in the proximal segment with wall calcification and 50% restrictive stenosis in the distal segment with intimal irregularity. An XB3.5 guiding catheter was then delivered to the left coronary port, and a 2.75×18 mm Cypher stent was disposed of in the diagonal branch lesion, and the stent was released at 16 atmospheric pressure with no residual stenosis on repeat angiography. Then another AmplatzAL1 guiding catheter was delivered to the opening of the vessel supplying the left ventricular sidewall, and a 3.0×13 mm Cypher stent was placed in the lesion, and the stent was released at a pressure of 22 atm. No residual stenosis was observed. Finally, a pigtail angiographic catheter was performed through the right coronary sinus to confirm the above findings. Coronary angiography diagnosis: coronary artery malformation coronary artery atherosclerosis