Facilitated Antegrade Steering Technique in Chronic Total Occlusions (FAST-CTOs)

Inclusion Criteria: * suitable candidate for non-emergent, coronary angioplasty * documented coronary CTO lesion with the following characteristics: a) Thrombolysis in Myocardial Infarction (TIMI) 0 flow for at least 90 days; b) satisfactory distal vessel visualization; and c) refractory to currently marketed guidewire crossing via 1 of the following: 1. previous failed attempt to cross CTO within the past 12 months; or 2. unsuccessful CTO crossing w/ guidewire (10-15 min fluoro time); or 3. attempt to cross CTO w/ guidewire results in subintimal guidewire * angina or ischemia caused by the occluded artery * at least 18 years of age * Body Mass Index (BMI) \< 40 * left ventricle ejection fraction \> 20% * sign the Informed Consent Form Exclusion Criteria: * saphenous vein graft (SVG) CTO or an in-stent CTO * aorto-ostial CTO location. (Ostial bifurcation origins may be considered) * intolerance to aspirin or a neutropenic response to Ticlopidine/Clopidogrel * appearance of thrombus or intraluminal filling defects * severe cerebrovascular disease (history of stroke or TIA within 1 month) * cardiac intervention within two weeks of the procedure * renal insufficiency (serum creatinine of \> 2.3 mg/dl) * active gastrointestinal bleeding * active infection or fever that may be due to infection * life expectancy \< 2 years due to other illnesses * significant anemia (hemoglobin \< 8.0 mg / dl) * severe uncontrolled systemic hypertension * severe electrolyte imbalance * anaphylaxis to angiographic contrast media unless appropriately medicated * congestive heart failure \[New York Heart Association (NYHA) Class IV\] * unstable angina requiring emergent percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft (CABG) * recent myocardial infarction (MI)(within the past two weeks) * uncontrolled diabetes * participation in another investigational protocol * unwillingness or inability to comply with any protocol requirements * pregnant or nursing * extensive dissection from refractory guidewire use * crossing CTO (true lumen) w/ guidewire within 10-15 min of fluoro time