Received 4 July 2014; revision accepted for publication 14 October 2014. A 67-year-old diabetic man was admitted for stable angina (CCS class II) despite optimal medical therapy. The echocardiogram showed hypokinesia of the lateral wall, with mild reduction of the left ventricular ejection fraction (50%). Coronary angiography revealed a CTO of the LCx, receiving collaterals (CC2) from the LAD via septal branches. LCx CTO revascularization was indicated. After a first unsuccessful antegrade attempt, we opted for a retrograde approach. A right 7-Fr femoral access was performed and a 7-Fr XB 4 guiding catheter (Cordis Co., USA) introduced in the left main coronary artery. A retrograde Sion guidewire (Asahi Intec Co., Japan) was employed with a Corsair microcatheter (Asahi Intec Co., Japan), and successfully reached the distal cap of the LCx CTO. A Miracle 6 guidewire (Asahi Intec Co., Japan) was able to cross the lesion retrogradely, and was inserted into the guiding catheter. However, the microcatheter was not able to advance because of the severe angulation of the LCx and Antegrade insertion in retrograde device: the AIRD technique. An efficient strategy in retrograde revascularization of chronic total occlusions