Case & Plan: 66-year-old female with known CAD presented with CCS Class IV angina. A Cardiac Cath on May 2, 2022 revealed 2 V + LM CAD: 95% proximal RCA, 60% distal LM, 90% mid LAD/D1 bifurcation with SYNTAX Score of 28. After a Heart Team discussion, CABG was recommended, but declined by the patient. Patient underwent successful PCI of proximal RCA using Promus Elite DES. Patient is now planned for IVUS guided staged PCI of LAD/D1 bifurcation and possibly Left Main.