The “double stingray technique” for recanalizing chronic total occlusions with bifurcation at the distal cap

Antegrade dissection re-entry is often discouraged for chronic total occlusions (CTOs) with a bifurcation at the distal cap due to risk of side branch occlusion that can lead to periprocedural myocardial infarction and incomplete revascularization. Antegrade dissection re-entry, however, is often needed, especially in complex cases. We present the novel “double Stingray technique” for CTOs involving bifurcations, in which the Stingray system is used twice for re-entry into both vessel branches, followed by two-stent bifurcation stenting to maintain the patency of both branches.