Successful wiring of a side branch or bifurcation is a significant step in some complex percutaneous coronary interventions (PCIs). Some anatomical subsets can be particularly challenging. Branch vessels arising at a retroflexed steep angle from the main vessel and those that arise from a stented segment pose major challenges. Some techniques that may help access difficult side branches include reverse hook, balloon backstop, twinpass catheter and deflecting tip guidewire.