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Recanalization of coronary artery chronic total occlusions is a rapidly developing domain of percutaneous coronary interventions requiring considerable operator expertise. Tackling any aorto-ostial lesion with previously implanted stent that protrudes into aorta presents anatomical and technical challenge significantly reducing procedure success rates and is an obstacle when considering antegrade approach in chronic total occlusion cases. We present an illustrative case report of successful antegrade recanalization of chronic total aorto-ostial in-stent occlusion of right coronary artery with previously implanted protruding stent.
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