57 year old diabetic male presented with new onset CCS Class II angina and positive stress echo for multisegmental wall hypokinesis. A Cardiac Cath on February 12, 2019 revealed diffuse 3 V and LM trifurcation disease with SYNTAX Score of 52 and EF = 55%. The Heart Team recommended surgical revascularization but was declined by the patient and family. The patient underwent DES PCI of RCA with excellent results. The patient is now planned for imaging-guided high-risk intervention of left main trifurcation, LAD and LCx disease with Impella LV support and dedicated 2-stent technique.