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A 94-year-old woman was admitted to the documented hospital with a 1-week history of intermittent angina. The electrocardiogram showed ST-segment depression in inferolateral leads and a high sensitivity troponin level was elevated. Echocardiography demonstrated hypokinesia of inferior, posterior and lateral walls. Urgent coronary angiography (CAG) was planned via the right radial approach after loading of acetylsalicylic acid 300 mg and clopidogrel 300 mg, but the right radial artery was pulseless. Therefore, CAG was performed via the left distal radial approach in the area of the “anatomical snuffbox”(Fig. 1A, B, Suppl. Video 1). CAG demonstrated diffuse intermediate to severe stenosis in proximal to mid right coronary artery (RCA)(Fig. 1C, left) and severe stenosis in the circumflex artery (LCx) and obtuse marginal branch (Fig. 1D, left). Thus, complete revascularization was achieved with 4.0× 9 mm and 3.5× …