Abstract
The treatment of chronic total occlusion (CTO) of coronary arteries allowed for a remarkable improvement in success rates and is represented by the introduction of the "Hybrid algorithm". An inability to cross the occlusion with a guidewire is the most common cause of failure of CTO revascularization. As antegrade options are limited, intervention upon the extreme angulation of the coronary artery warrants a retrograde approach. Here, we report a 58-year-old man with symptoms of effort angina complicated with three-vessel disease and CTO of the right coronary artery (RCA). Left main artery bifurcation lesions were treated with systematic two-stent strategies and intervention upon RCA CTO after three months by means of a combination of the antegrade and retrograde approaches. The RCA was eventually revascularized by the implantation of stents, and no adverse events were observed during hospitalization.