Visual Summary.

Timeline of Events

	Event
Initial presentation	77-year-old man with angina and prior PCI history
First CTO-PCI attempt	False lumen stent implantation from the crux to the PL branch and dissection of the right aortic sinus
Retrograde approach	Retrograde CTO-PCI via a septal collateral; the wire successfully crossed the PD branch
Microcatheter complication	Microcatheter stuck with the wire, chest pain, and instability
Cardiogenic shock	Stent crush and LAD occlusion, leading to cardiogenic shock
Re-establish LAD patency	CTO techniques to cross and stent the LAD successfully
Hemodynamic support	Five days later Impella CP used for support after atrial fibrillation and cardiopulmonary resuscitation
Final outcome	Patient stabilized and discharged 8 days later after removal of Impella

CTO-PCI = chronic total occlusion percutaneous coronary intervention; LAD = left anterior descending artery; PCI = percutaneous coronary intervention; PD = posterior descending artery; PL = posterolateral artery.