A patient presented with NSTEMI and was found to have thrombotic occlusion of the distal RCA with an ulcerated lesion in the mid RCA. Wiring the RCA was challenging but was achieved using a Sion black guidewire and a Caravel microcatheter. Thrombectomy was performed using an Export catheter and the Penumbra system. A large amount of thrombus was retrieved restoring antegrade coronary flow. A stent was delivered to the distal RCA, but attempts to deliver a 3.5x38 mm DES led to guide and wire position loss. The RCA could not be rewired (the wire entered the subintimal space). Re-entry with a Stingray balloon failed. Retrograde crossing also failed. Repeat attempts for antegrade wiring were successful using the Stingray balloon and a Gladius Mongo guidewire, followed by stenting, repeat thrombectomy and an excellent final result.