47-year-old female with ESRD on HD, presented with CCS Class I angina and a markedly positive SPECT MPI for anterior and lateral wall ischemia. A Cardiac Cath on February 23, 2021 revealed severely calcified 1 V CAD: 90% proximal LAD and diagonal bifurcation (Medina 1,1,1), 80% mid LAD and SYNTAX Score of 23 with normal LV function. Patient is now planned for IVUS guided PCI of severely calcified LAD-D1 bifurcation using rotational atherectomy (step burr 2.0 and 2.25m) and dedicated two-stent mini-crush technique.