90 year-old female presented with dyspnea on exertion and a stress MPI test revealed moderate apical and anteroseptal ischemia as well as RV dilation. A Cardiac Cath on October 21, 2016 revealed 3V + LM CAD: 70% ostial LM, 80%-90%, prox-mid LAD with 85% diagonal branch, 70% prox LCx and 60% in-stent restenosis RCA with normal LVEF; SYNTAX Score of 32. Patient underwent Heart Team discussion and then opted for complex multi-vessel PCI. Patient is now planned for Rotational Atherectomy and DES PCI of complex LM/LCx/LAD bifurcation lesions.