Prayaga S et al. – With the advent of new tools and techniques including the retrograde approach, success rates for recanalization of chronic total occlusion (CTO) have improved. Numerous cardiac and extracardiac complications during retrograde CTO recanalization have been described. To date the development of ST–segment elevation myocardial infarction (STEMI) with retrograde recanalization as a result of atheroembolization has not been reported. Authors report such a case following retrograde recanalization of a totally occluded right coronary artery.