Edin Dzeko had opened the scoring and Roma rattled the woodwork three times, but Mauro Icardi inspired an Inter comeback to win 3-1.
It is the first time the Nerazzurri have won this fixture in Serie A since 2008.
The Giallorossi could consider themselves unlucky at the Olimpico, as after Dzeko’s opener they hit the frame of the goal with Radja Nainggolan, Aleksandar Kolarov and Diego Perotti.
There was also controversy, as VAR was not consulted when Milan Skriniar appeared to trip Perotti in the penalty area.
Icardi scored two very similar goals to turn it around completely, spinning on the spot to fire into the near bottom corner.
As Roma were pouring forward, the visitors struck again on the counter, Matias Vecino tapping in an Ivan Perisic assist.
It was a return to Rome that Luciano Spalletti could really relish against his former club.
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