Fixed-wire (FW) coronary angioplasty procedures have gained widespread acceptance in some institutions as a primary choice for all angioplasty procedures. These single-lumen, low-profile devices provide distinct advantages as compared to over-the-wire systems in certain circumstances. However, they have not allowed for lesion protection or guidewire access if the situation arises. Two techniques are available to provide lesion protection during FW coronary angioplasty. They are the buddy wire technique and the use of subselective intracoronary access catheters. Access catheters can be used as primary, pre-loaded devices or as secondary devices to be used over an extended FW balloon catheter. These techniques can widen the applications of FW balloon angioplasty.