This case report describes the recanalization of a chronic total occlusion in the circumflex artery in an 80-year-old man with prior coronary artery bypass grafting and stent placement. A hybrid retrograde approach was used involving crossing the CTO from collateral vessels and placing a wire antegrade through the CTO. This reopened the circumflex artery but caused an occlusion of the obtuse marginal branch, which was then reopened with a reverse retrograde approach through collateral vessels. Final kissing balloon angioplasty was performed and the circumflex artery and obtuse marginal branch were successfully reopened.