Project Summary/Abstract We propose to develop an innovative wiring catheter system to reliably direct subintimal crossing and re-entry into the artery true lumen during treatment of complex arterial chronic total occlusions (CTO). The proposed system will improve techniques for treating complex CTOs during percutaneous coronary and peripheral artery interventions (PCI). Atherosclerosis drives development of coronary artery, cerebrovascular, and peripheral arterial disease. Improved CTO crossing devices and techniques will allow more operators to perform these procedures and improve patient care. The proposed project investigates key elements of a novel guided re-entry catheter system to be used in a rendezvous maneuver to increase the precision, speed, reliability, and safety of retrograde CTO PCI crossing. A prototype device will be developed and evaluated.