BACKGROUND: Transradial coronary intervention (TRI) is a safe and effective method of percutaneous coronary intervention (PCI). However, there is limited data on the efficacy and the safety of the TRI for chronic total occlusion (CTO). METHODS: 176 consecutive CTO patients, who underwent PCI due to typical angina between June 2006 and February 2009 were analyzed. According to vascular access site, we divided into 2 groups: Group I (TRI, n=72) and Group II (transfemoral intervention, n=104). We compared baseline and angiographic characiteristics, procedural failure rate, and major adverse cardiac event (MACE) at 1 month and 6 months. RESULTS: There were no significant differences in age (63짹10 vs. 67짹9 years, p=0.1), hypertension (73 vs. 75%, p=0.9), diabetes (39 vs. 33%) between groups. In both groups, male is dominant (92 vs. 91%, 0.9). In angiographic findings, rate of multi-vessel disease (81 vs. 86%, p=0.7), blunt stump (58 vs. 39%, p=0.1), heavy calcification (26 vs. 17%, p=0.3), and dissection were not different between groups. Furthermore, procedural failure (22.6 vs. 29.2%, p=0.5), MACE at 1 month (4.4 vs. 5.6%, p=0.8), and MACE at 6 months (14.0% vs. 22.2%, p=0.4) were not significant difference between the two groups. CONCLUSION: TRI may be not inferior than TFI in procedural success and long-term clinical outcome.