61 year old male presented with CCS Class I angina and intermediate risk positive SPECT MPI for inferior and lateral ischemia done as the part of pre-op evaluation for shoulder surgery. A Cardiac Cath on May 7, 2019 revealed II Vessel CAD: 90% mid RCA DES ISR, 80% distal RCA, CTO of small distal LCx, 80% calcified Ramus Intermedius with SYNTAX Score of 20 and normal LV function. Patient underwent successful intervention of Ramus Intermedius using rotablator and Promus Premier DES. Patent ostial RCA stent is protruding 5-6mm outside the ostium causing difficulty in engaging the RCA. Patient is now planned for staged PCI of complex RCA (due to stent protrusion) using rotational atherectomy and DES.