66-year-old female with Class I angina had low risk stress MPI as a pre-op for knee surgery. A Cardiac Cath on March 28, 2021 revealed severe 3V CAD with SYNTAX Score of 20 and LVEF = 60%. Patient was cleared to undergo knee replacement surgery under medical optimization. Patient was brought back to undergo PCI and underwent staged PCI of LCx-LPL on July 18, 2021. Now planned for imaging guided tortuous calcified mid LAD/Diagonal bifurcation using RA + IVL (RotaTripsy) and dedicated 2-stent Mini-Crush technique.