Figure 4: CTO with tight distal bend
When the distal portion of the CTO is located on a tight bend, if you try to go straight for the main trunk, as in (b), you risk creating a false lumen as in (c) and (d). If, the side-branch is co-axial to the wire, going instead for the side-branch, as in (e), will give you a much better chance of getting through the distal fibrous cap at the end of the CTO.