58-year-old female presented to OSH with NSTEMI on May 28, 2021. A Cardiac Cath on June 1, 2021 revealed 2V CAD: 80% long LAD lesion and heavily calcified ulcerated 90% mid RCA, SYNTAX Score of 20 and LVEF = 50%. Patient underwent successful PCI of mid LAD and unsuccessful NC balloon/scoring balloon PTCA of the mid RCA due to severe lesion calcification and residual 70% lesion. A follow up stress MPI revealed significant inferior ischemia and normal LVEF. Patient is now planned for ‘Rota-Shock’ PCI of calcified undilatable mid RCA lesion with IVUS guidance.