76-year-old female presented with new onset CCS Class III angina with positive SPECT MPI for mild lateral ischemia. A Cardiac Cath on January 6, 2020 revealed 3 V + LM CAD: 70% distal LM, 80% proximal LAD/D1 bifurcation, 80% long calcified aneurysmal mid LAD, 80% LCx-OM1, SYNTAX Score of 35 and LVEF of 60%. In view of high SYNTAX Score, patient was referred for Heart Team discussion with recommendation for CABG, which was declined and patient opted for multi-vessel PCI. Patient underwent RCA PCI using Xience Sierra DES and discharged home. Now planned for OCT guided complex intervention of LM and long calcified aneurysmal proximal to mid LAD lesions.