57 year-old male presented with new onset CCS Class IV angina. A Cardiac Cath on April 6, 2015 revealed 2V CAD (CTO of RCA and subtotal occlusion of Circumflex-LPL branch) with normal LV function and SYNTAX Score of 24. Patient underwent successful intervention of LCx-LPL (Xience DES) and failed attempt at antegrade recanalization of CTO RCA. Subsequently, patient continued to have Class II angina and a stress MPI last week revealed moderate ischemia in the RCA territory. Now planned for staged PCI of CTO RCA via retrograde approach due to failed ategrade approach.