Distal side branch entry technique to accomplish recanalization of a complex and heavily calcified chronic total occlusion.

Percutaneous intervention for complex coronary chronic total occlusions (CTO) remains challenging in spite of the improvement in wiring techniques and devices available today. The antegrade wiring approach remains the most common method for crossing and intervening in chronic total occlusions. Distal intraluminal wire placement is the most critical step in accomplishing recanalization of a chronic total occlusion. Creation of multiple dissection planes with wires is not an uncommon occurrence prior to success. We describe the use of distal side branch entry to prove luminal entry and subsequent use of the contralateral injection technique to guide distal wire placement after utilization of the parallel wire technique to recanalize a long, calcified and complex chronic total occlusion.