Despite advances in new devices, equipment, and expertise, percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) remains difficult and technically challenging. In recent years, development of the retrograde approach via intra-myocardial septal or epicardial collaterals has improved its success rate, even in cases of antegrade PCI failure. Most PCI experience for CTO was using femoral access, where the trans-radial (TR) approach is considered not suitable, due to there being less back-up support with smaller guiding catheters (5-6 Fr.), or the difficulty of taking contralateral coronary angiography. We present here a challenging case of left anterior descending CTO in a 49-year-old male smoker, in which the successful PCI was achieved via bilateral radial access and primary retrograde approach.