We report the case of a patient with absence of the left main coronary artery associated with close origin of the left coronary branches and a subocclusive proximal lesion of the left anterior descending coronary artery involving the ostium. Two guiding catheters were used for selective cannulation of the separated ostium and wiring of both branches was obtained. This approach allowed us to recognize the optimal stent position and then to correctly deploy it on the proximal left anterior descending coronary artery. The absence of the left main coronary artery is a relatively rare finding and experiences concerning ostial stenting in patients with anomalous origin of the left anterior descending and circumflex coronary arteries are limited. In this case report we suggest and discuss about a new procedure that allows the treatment of such condition by direct stenting.