48-year-old male with known multivessel CAD since 2012 and prior PCI’s of LAD, Ramus and Circumflex presented with CCS Class III angina and moderate inferior wall ischemia on stress MPI. A Cardiac Cath on September 2, 2015 revealed one vessel CAD: CTO of distal RCA filling via retrograde LAD-septal collaterals and antegrade bridge collaterals, and patent interventional sites of left system with normal LV function and SYNTAX Score of 12.0. Patient is now planned for PCI of distal RCA CTO by retrograde recanalization approach using LAD-septal collaterals.