A 66-year-old man underwent percutaneous coronary intervention (PCI). Coronary angiography showed a diffuse lesion with lotus root appearance and severe stenosis in the left anterior descending artery (LAD). Multiple channels were observed by intravascular ultrasound (IVUS). Different channels were connected to the first diagonal branch, the first septal branch and LAD lumen separately. To prevent obstruction of side branches, we made connections to the branches from the main channel of LAD with tapered-tip guide wire, followed by balloon dilatation and stenting without side branch obstruction. IVUS findings were helpful for the PCI with a lotus root appearance lesion.