68-year-old female presented with new onset CCS Class III angina and positive SPECT MPI for multivessel ischemia. A Cardiac Cath on December 20, 2021 revealed 3 V + LM CAD: 80% distal LM (1,0,0) with 70% proximal LAD, 90% proximal LCx, 95% proximal RCA, 90% RCA-RPDA with SYNTAX Score of 32 and normal LV function. After Heart Team discussion, patient underwent successful intervention of proximal RCA and RPDA branch using Promus Elite DES. Patient is now planned for staged PCI of LMCA and LAD/LCx using imaging and Mini-Crush technique.