Background: Retrograde wire approach has been emerged as an useful technique to enhance success rate in chronic total occlusion (CTO) intervention. Therefore, we tried to report the initial experience of retrograde approach and its clinical implication on CTO intervention. Material & methods: 31 retrograde approaches were attempted out of 60 CTO patients since February 2007(22 male, mean age 62 yrs). Procedures were done with both femoral approaches. Hydrophilic coated guidewire was inserted by using microcatheter or over-the-wire (OTW) balloon during the collateral channel (septal or epicardial channel) selection. Superselective injection was done via microcatheter or OTW balloon and septal dilatation was done during the procedure if needed. Results: Involved artery included LAD (n=16), RCA (n=14), and LCx (n=1). Septal channel was used in most of the cases. In 3 cases, epicardial vessels was used. Guidewire was not passed through the septal channel in 6 patients. In 9 patients, retrograde wire was reached only distal to CTO lesion. In 16 patients, retrograde guidewire crossed through the occluded site. Procedural success by retrograde approach was achieved in 20 patients (success rate 64.5%). During the later phase (n=16), success rate increased dramatically after learning period (n=15) (40% vs. 88%). Procedure related complication included one myocardial infarction and 3 collateral channel dissections, which did not resulted in significant events. Conclusion: Retrograde approach is evolving technique to improve the success rate of CTO intervention. After the learning curve period, this technique could be the useful tool to enhance success rate in CTO intervention.