An 84-year-old male with history of diabetes, hypertension, and hyperlipidemia presented with severe triple-vessel disease: diffuse disease in circumflex artery and LAD, and a CTO of the RCA. His LVEF was 40% and syntax score of 29, and he had mild aortic stenosis. He was referred for surgical CABG; however, he refused and requested PCI. Dr. Rajesh Dave and Dr. Andreas Wali treat this complex and risky patient with the hemodynamic support of the Impella 2.5 partial-circulatory-support device.