58 year old female presented with NSTEMI and CCS Class III angina on February 28, 2019 at OSH. A Cardiac Cath on March 12, 2019 revealed 3 V & LM CAD: 90% RCA-RPL, 80% mid RCA, 80% distal left main bifurcation, 80% proximal LAD/D1 bifurcation, 80% proximal LCx with SYNTAX Score of 35 and LVEF 50%. After Heart Team discussion, high-risk staged PCI was decided. Patient underwent successful intervention of RCA using two Promus Premier DES. Patient is now planned for high-risk staged PCI of LM bifurcation and LAD/D1 bifurcation using Impella LV assistance.