64 year-old female presented with new onset Class III angina and CTA revealed significant calcified LAD and Ramus disease. A Cardiac Cath on August 2, 2016 revealed 2V CAD: 80% calcified proximal LAD and diagonal bifurcation lesion (Medina 1, 1, 1) and 95% Ramus Intermedius with normal systolic LV function; SYNTAX Score of 21. Patient underwent successful interventional of Ramus Intermedius using Promus Premier DES. Patient continued to have Class II angina despite maximal medical therapy. Patient is now planned for staged PCI of calcified LAD-D1 bifurcation lesion using Rotational Atherectomy and Absorb BVS in LAD and metal DES in diagonal.

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