65 year old male with known extensive CAD and prior PCI’s in 2008, presented with NSTEMI (TnI 0.54). A Cardiac Cath on August 6, 2018 revealed 3 V CAD: Subtotal prox RCA and 90% mid RCA DES ISR, 70% proximal LAD DES ISR, 95% multiple calcified proximal LCx lesions, and subtotal small LCx-LPL1 with SYNTAX Score of 25 and LVEF of 60%. Patient underwent successful intervention of culprit proximal and mid RCA using rotational atherectomy and two Promus Premier DES. Subsequently patient had stress MPI revealing moderate to severe lateral and interolateral ischemia and mild anterior ischemia. Patient is now planned for staged PCI of proximal LCx and proximal LAD with dedicated 2 stent technique and OCT imaging guidance.