83 year old male presented with new onset CCS class II angina and progressive dyspnea. Patient has known severe aortic stenosis and normal EF and is being medically managed. A Cardiac Cath on November 22, 2016 revealed calcific 3V + LM CAD; 70% dLM, 80% mid LAD, 80% LCx-OM2 and 100% mid RCA with SYNTAX score of 38. STS mortality risk is 3.1. After Heart-Team discussion, high risk PCI and BAV is recommended due to aortic calcification and PAD followed by TAVR in few weeks. Patient is now planned for BAV and Rota + DES of LM, LAD and LCx-OM2 lesions in preparation for high risk TAVR.