"Ping-pong" guide catheter technique for retrograde intervention of a chronic total occlusion through an ipsilateral collateral.

We report a novel technique for performing retrograde interventions on a coronary chronic total occlusion through an ipsilateral collateral. Two guiding catheters are used to engage the target coronary artery, one to advance to the retrograde guidewire and the other to externalize the retrograde guidewire and antegrade wiring. Engagement of the target coronary artery is alternating between the antegrade and the retrograde guide catheter in a "ping-pong" fashion, enabling lesion crossing and equipment delivery.