67-year-old male controlled NIDDM, presented with CCS Class I angina and positive stress echo for multi vessel ischemia. A Cardiac Cath on August 9, 2019 revealed 3 V CAD: calcified 80% mid LAD and D2 bifurcation, 70% distal LAD, CTO mid RCA and CTO proximal LCx, SYNTAX Score of 38 with moderate systolic LV dysfunction.

After Heart discussion patient declined CABG and high risk multi staged PCI of all 3 vessels for complete revascularization was planned. Patient initially underwent successful PCI of LCx (3 Synergy DES) and then one month later PCI of RCA (3 Synergy DES). Patient is now planned for OCT guided PCI of LAD/D2 bifurcation using dedicated 2-stent technique after orbital atherectomy.