A patient was referred for PCI of an LAD CTO. The LAD had an ambiguous proximal cap, length of approximately 25 mm with diffusely diseased distal vessel that was filling via septal collaterals from the RCA. An IVUS was inserted in the diagonal branch clarifying the proximal cap ambiguity. IVUS-guided puncture succeeded in crossing the proximal cap. After advancing a Corsair XS into the occlusion, the CTO was crossed with a Gladius Mongo wire into a diagonal branch at the distal cap. The Sasuke catheter was used to advance a workhorse guidewire into the LAD, followed by successful stenting.