Ostial left anterior descending artery chronic total occlusion – Left main coronary artery intramural hematoma

Chronic total occlusion (CTO) intervention of ostial left anterior descending artery lesion without clear cap poses challenges for wiring. Intravascular ultrasound-guided antegrade cap puncture and guide extension-assisted reverse-controlled antegrade and retrograde tracking away from the ostium would minimize inflow injuries. This case report explores inflow injury and its detection by imaging in ostial left anterior descending artery CTO percutaneous coronary interventions.