Team Jumbo-Visma’s Roglic, the pink jersey, emerged unscathed from the high-speed pile-up in a leading group of a dozen riders and finished sixth in the stage to extend his lead over most his rivals by 16 seconds.

But Team Sunweb’s Dumoulin, the 2017 champion and last year’s runner-up, went down heavily in the crash and crossed the line surrounded by team-mates more than four minutes down with his left-knee bloodied.

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Big crash takes out Dumoulin and holds up peloton

Victory on the day went to Movistar’s Carapaz, who darted clear on the final rise into Frascati before dying a thousand deaths as he clung on to defy a late surge form the Australian Caleb Ewan.

Lotto Soudal’s Ewan took second place and Italy’s Diego Ulissi (UAE Team Emirates) third, with German’s Pascal Ackermann (Bora-Hansgrohe) and Frenchman Florian Senechal (Deceuninck-QuickStep) completing the top five two seconds down and ahead of Roglic.

Watch Carapaz hold off Ewan to win Stage 4

The Slovenian race leader seemed torn as to whether he should twist the knife following the incident which saw all his rivals held up. And while the 29-year-old clearly didn’t push on to the line, Roglic nevertheless managed to extend his lead to 35 seconds over Britain’s Simon Yates (Mitchelton) and a further four seconds on Vincenzo Nibali (Bahrain Merida).

Colombia’s Miguel Angel Lopez (Astana) retained his fourth place in the general classification, 44 seconds down, while Ulissi rose to fifth at the expense of the battered, bloodied and bruised Dumoulin, whose participation in the race must now be in doubt.

Other big losers on the day included Carapaz’s Spanish teammate Mikel Landa, who conceded 44 seconds, Spain’s Ion Izagirre (Astana) and Italy’s Domenico Pozzovivo (Bahrain Merida), both of whom shipped more than 10 minutes.

Yates was one of the riders who hit the deck, but the reigning Vuelta champion was able to remount and limit his losses on another dramatic day on the 102nd editoin of La Corsa Rosa.

Stage 4: Orbetello to Frascati, as it happened

The third longest stage of the race played out largely in sunshine as the riders left Tuscany and entered Lazio via persistently undulating roads.

Three Italians darted clear of the peloton from the gun – and not for the first time so far in this year’s race. Marco Frapporti (Androni-Sidermec), Mirco Maestri (Bardiani-CSF) and Damiano Cima (Nippo-Fantini-Faizanè), who were all part of Sunday’s eight-man break in stage 2, managed to build up a maximum lead of over 12 minutes as the peloton pootled along at a leisurely pace in blustery but mild conditions.

Frapporti, the most aggressive rider from last year’s Giro, took maximum points on the only categorised climb of the day, the Cat.4 rise to Manciano, to move within twenty points of maglia azzurra Giulio Ciccone (Trek Segafredo) in the KOM competition.

The other two Italian riders divvied up the remaining prizes: Maestri won the first intermediate sprint at Vetralla with 120km remaining before Cima zipped clear in Mentana to win the second sprint at Mentana.

Meanwhile, their lead had fluctuated according to the whims of whichever teams committed men to the chase. With the gap still over eight minutes with 90km remaining, Frapporti – the best placed rider at 6’19” from the summit – would have been forgiven thinking about the virtual pink jersey turning into the real thing.

But constant marshalling from Roglic’s Jumbo-Visma team – plus additional work from Lotto Soudal, Deceuninck-QuickStep, Bora-Hansgrohe, Groupama-FDJ and UAE Team Emirates – meant the gap came down to four minutes entering the final 40km, whereby ending any lingering hopes of the maglia rosa for Frapporti.

And when Vincenzo Nibali’s Bahrain Merida piled on the pressure alongside Simon Yates’s Mitchelton-Scott, the gap tumbled, and the breakaway death-knell was sounded.

Cima was the first to feel the pinch, the Grand Tour debutant dropped by Frapporti and Maestri with 20km remaining as the advantage dropped below two minutes on a long uphill drag.

The remaining Italian duo was swept up with 10km remaining having spent 223km on the head of the race – shortly after a spill in the pack saw Britain’s James Knox (Deceuninck-QuickStep) hit the deck for the second day running.

It was a sign of things to come. With 6km remaining and the peloton rampaging along at top speed and jostling for positions, a touch of wheels on the front involving Italy’s Salvatore Puccio (Team Ineos) caused a huge pile-up.

Riders were sent sprawling across the road, on the grass verge and in a ditch. Moments later, at a roundabout, a second incident brought down more riders including Dumoulin and the Vuelta champion Yates, who fell on his knee and hip but managed to remount and limit his losses to just 16 seconds.

No such luck for Dumoulin, who came off the worst of the GC favourites. The 28-year-old looked to be in considerable pain as he battled on to the finish with five Sunweb teammates to come home 4’04” down on the winner.

Carapaz, a stage winner in his debut Giro last year, doubled up with a timely attack inside the final six-hundred metres.

Around 20 riders were in the leading group following the split caused by the crash. Ulissi had two UAE Team Emirates teammates riding high tempo as the likes of sprinters Elia Viviani (Deceuninck-QuickStep) and Arnaud Demare (Groupama-FDJ) were distanced.

A dozen riders hit the foot of the final 2km climb to the line, whittled down to eight riders going under the flamme rouge.

Mindful of the presence of fast-men Ewan and Ackermann, 25-year-old Carapaz kicked out near the top of the 7% incline, taking advantage of some indecision between Roglic and Ulissi. The chase was left to Ewan but the pint-sized Australian ran out of road.

The Ecuadorian was a worthy, if opportune winner – turning the tables after losing time 24 hours earlier with a late mechanical and a hold-up following a crash.

Ackermann's fourth place was enough to see the German back into the maglia ciclamino. But the story of the day was Dumoulin, whose chances of a second victory in La Corsa Rosa were dealt perhaps a fatal blow.

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