Novel techniques for percutaneous revascularization of chronic total occlusions or other complex coronary lesions utilize the subintimal space to safely and efficiently traverse the occluded coronary segment. Antegrade and retrograde dissection reentry is gaining popularity, and is an elegant method to successfully cross coronary chronic total occlusions. We describe a "subintimal space plaque modification" that involves use of antegrade and retrograde dissection reentry techniques to treat "balloon-uncrossable" coronary lesions.