73 year old male with known CAD and prior PCI in 2011, presented with CCS Class IV angina and palpitation due to new onset Afib requiring successful cardioversion. A Cardiac Cath on February 26, 2018 revealed calcific 3V + LM CAD: 60% distal LM bifurcation, 90% proximal calcific LAD, 80% D1, 90% D2 and 95% proximal LCx with SYNTAX Score of 34 and LVEF 50%. Patient underwent Heart Team discussion and CABG was declined due to significant pulmonary fibrosis and staged PCI was recommended. Patient underwent successful intervention of proximal RCA using Promus Premier DES. Patient is now planned for complex PCI of LM/LAD-Diagonal/LCx bifurcation using rotational atherectomy and DES.