77 year old male with known chronic systolic heart failure presented with new onset CCS Class III angina and a positive stress MPI. A Cardiac Cath on May 11, 2017 revealed III Vessel CAD: 100% calcified proximal RCA, 95% LAD-D1 bifurcation, 100% calcified proximal LCx and SYNTAX score of 54.5 with severe LV dysfunction, EF 20%. Cardiac MRI showed viability in all three coronary territories. After Heart Team discussion, CABG was recommended, but declined by CT surgeon due to severe biventricular dysfunction. Now planned for complex high-risk protected PCI of RCA CTO and/or LAD/D1 lesions with Impella LV support.