86 year old female with chronic stable angina CCS Class II and positive MPI for two years being managed on medication. A Cardiac Cath on May 14, 2018 revealed severed calcific 2V + dLM bifurcation disease, prox LAD focal aneurysm and normal LV function and SYNTAX Score of 30. CABG was recommended, but declined by the patient and family due to old age and poor coordination. Patient is planned for revascularization of complex calcific left main bifurcation using rotational atherectomy and planned one-stent crossover technique with IVUS guidance.