Distal open sesame and hairpin wire techniques to facilitate a chronic total occlusion intervention

We describe a novel distal "open sesame" and "hairpin wire" technique application in a right coronary artery (RCA) chronic total occlusion intervention. Antegrade wiring was successful in entering an acute marginal branch distal to the occlusion, but not the mid RCA. After predilation, antegrade flow was restored but the mid RCA could not be wired in spite of using multiple different guidewires. A "hairpin" was created in a polymer jacketed guidewire, advanced into the acute marginal branch, and withdrawn, allowing wiring of the mid RCA, which was successfully stented using a variety of guide support and lesion preparation techniques.