51 year old male with history of NIDDM has CCS Class II angina and high risk stress MPI for multi vessel ischemia. A Cardiac Cath done at outside hospital revealed two vessel CAD with calcific total occlusion of mid LAD, 80% D1, 80% prox-LCx and 99% LPL with LVEF 55% and SYNTAX Score of 22. Patient had Heart Team discussion, which recommended CABG, but patient elected for PCI. Patient continued to have angina despite MMT. Patient is now planned for revascularization of totally occluded mid LAD via antegrade and/or retrograde approach.