The role of internal mammary artery grafts in facilitating retrograde chronic total occlusion interventions is controversial. We describe two cases demonstrating: (a) retrograde wiring via a left internal mammary artery graft; and (b) using the left internal mammary graft for vessel visualization while retrograde crossing to the right coronary artery was achieved via the native left main coronary artery (triple arterial access). The internal mammary artery grafts can facilitate retrograde chronic total occlusion interventions, but should be used with caution to minimize the risk of injury.