How do you treat diffuse LAD?

Proximally would stent it. The very Distal will leave it.

Prox DES. Distal CBA + DCB?

Distal DCB proximal DES

I would stent LM to mLAD and DCB the distal lesions. The dLAD is collateralized so I would be very tolerant with dissections to avoid stenting it

Hybrid, DES prox. DCB to distal.

LM>LAD DES , POBA/DCB TO DISTAL LAD

DES for prox LAD ,,DCB for dLAD

@murshid_eyad2 Treat the ostial lesion leave the apical for medical treatment

I would fix proximal. You have a landing zone. Distal LAD - DCB if you have them. I would fix LCX focal lesion for sure. You should be fine with IVUS guided PCI and good vessel preparation. This is not a good artery for LIMA unfortunately.