58 year old male presented with new onset CCS Class II angina and a positive stress MPI for inferior and lateral ischemia. A Cardiac Cath on September 5, 2017 revealed LM and III Vessel CAD: multiple lesions in RCA with distal total occlusion, 70% calcified distal LM (MLA 4mm2 on IVUS), 70% ostial diagonals, 80% proximal LCx-OM1 bifurcation (Medina 1,1,1), 60% proximal ramus with SYNTAX Score of 51 and LVEF = 60%. Patient was recommended CABG, but declined after Heart Team discussion. Patient then underwent PCI of RCA using four DES (Xience Alpine). Patient is now planned for staged PCI of LM and LCx using rotational atherectomy and DES with IVUS guidance.