50-year-old female with multiple CAD risk factors presented with new onset CCS Class II angina for two months and stress echo revealed moderate inferior ischemia. A Cardiac Cath on October 7, 2019, performed at an outside hospital, revealed 1 V CAD: CTO of prox RCA, which fills via collaterals from left system with non obstructive left system, SYNTAX Score of 9 and LVEF 60%. The RCA CTO is long and calcified with J-CTO Score of 4. Patient is now planned for PCI of RCA CTO using rotational atherectomy and stents via antegrade approach and if failed, then retrograde approach.