Both femoral arteries were assessed with 7F sheaths. The left coronary artery was engaged with a 7 Fr EBU 3.75 guiding catheter and right coronary artery was engaged with a 7 Fr JR 4.0 guiding catheter. We tried the anterograde approach using Sion blue, fielder XT-R, Gaia 1 with Corsair 150cm micro-catheter, but it was not successful ( Movie 3). After that, we tried retrograde approach using Sion blue, SUOH wire with Caravel 150cm micro-catheter and using SUOH, Ultimate 3, miracle 3 with FINECROSS micro-catheter ( Movie 4, Movie 5). After careful subintimal tracking of the retrograde guidewire directed to the tip of antegrade guidewire, the subintimal space was dilated with PCI balloons (IKAZUCHI zero 1.0 x 6 mm, Tazuna 2.0 x 15 mm in antegrade direction ( Movie 6, Movie 7). Then retrograde wire was linked up with the antegrade wire in proximal true lumen, and the retrograde wire was externalized into the LAD guiding catheter ( Movie 8). It was followed by the usual PCI procedure. Predilatations were performed with Tazuna 2.0 x 15 mm balloon at the pmLAD. After predilatation, we deployed two Ultimaster stents (2.5 x 38mm and 3.5 x 24mm) sequentially ( Movie 9, Movie 10). Post dilatation of the proximal to middle LAD was performed with NC Rovl 2.75 x 15 mm and Tazuna 2.0 x 15 mm. The final angiogram showed successful revascularization at the LAD CTO lesion ( Movie 11).
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