We describe a new technique for angioplasty of totally occluded coronary arteries and bypass grafts in the absence of acute myocardial infarction. We used a guiding catheter, a coronary infusion catheter, and a relatively stiff steerable guide wire to perforate the occlusion. Angioplasty of the recanalized vessel was subsequently performed. The procedure was attempted in nine patients; it was successful in eight. There were no complications. The advantages of this technique are discussed.