In percutaneous coronary intervention (PCI) procedures, stenting at complex lesions with severe calcification could result in stent restenosis and stent failure more often than those without. Therefore, coronary interventionists should pay close attention to the use of stents in complex lesions involving a bifurcation and severe calcification [1]. Notably, a calcified nodule (CN), which is a type of calcified plaque, is often responsible for stable angina or acute coronary syndrome. However, the probability of its occurrence is comparably low [2], and the optimal therapy for these lesions is not well clarified [3]. We report a patient who presented with stable angina with a CN at the ostial left circumflex artery (LCX). We successfully performed lesion modification with excimer laser coronary atherectomy (ELCA) and scoring balloon dilatation, followed by PCI with drug-coated balloon (DCB) dilatation and optical frequency domain imaging (OFDI). Case report The patient, a 71-year-old-man, presented to our hospital in December 2014 with exertional angina. The patient characteristics are displayed in Supplemental Figure 1A and 1B. A coronary computer tomography angiogram showed heavy calcification in entire coronary vessels, and invasive coronary angiography (CAG) was performed in January 2015 (Fig. 1). CAG showed significant stenosis in the ostial LCX and distal right coronary artery (RCA). The lesion in the distal RCA was successfully treated with stenting first.