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Based on the patient's symptoms and examination, a decision was made to recanalize his totally occluded RCA via retrograde approach through the SVG to the OM. Due to inadequate visualization of the epicardial collaterals and distal RCA via SVG, triple-access was used and injection via left main. In selected CTO cases, triple access may facilitate the retrograde approach, allowing optimal collateral visualization.Our case illustrates the feasibility of high-risk PCI to salvage LMCA stenosis, possibly caused by coronary injury during dire