As the world advances, living standards are getting changed with inclination more toward sedentary life style and junk food, we are seeing a worldwide increased incidence of coronary artery disease. A 73 year of age gentleman with progressive shortness of breath NYHA-II/III since last 6 months and epigastric discomfort with effort angina CCS-III. Was having no other co-morbidities, except of 35 pack years of smoking. On evaluation his Coro-angiogram revealed Diffuses TVCAD with Lad diffusely diseased throughout its middle course >90%, LCX 80%, RCA mid-Course critical discrete lesion of 90%. His 2D, TTE showed normal valvular apparatus and ejection fraction of 55%. Literature review further furnishes the fact that LAD is most commonly being affected by atheroma formation hence making it the most common site for endartrectomy, though peri-operative MI is still a grave concern, but half dose protamine slow reversal of the heparin and keeping ACT at 150-160 sec greatly reduces the incidence of peri-operative MI.