Fig. 2

Double snare piercing technique. A Two snares from antegrade and retrograde access sites were placed in the same level and the two loops were aligned. B micro-puncture needle was inserted from the skin through the two loops. C A 0.014-inch guidewire was advanced after removing inner needle, and the outer needle was retrieved. D The retrograde snare grasped the wire and was pulled until the it was externalized, and the middle part of it came to the occluded lesion. E The antegrade snare was pulled so that the wire could cross the lesion. F A microcatheter was advanced along the externalized wire from retrograde side and crossed the lesion