Successful transradial antegrade coronary intervention of a rare right coronary artery high anterior downward takeoff anomalous chronic total occlusion by double-anchoring technique and retrograde guidance.

Percutaneous coronary intervention (PCI) via a transradial approach has become feasible for the treatment of chronic total occlusion (CTO). However, abnormalities such as anomalous origin coronary arteries represent the most technically challenging cases for interventional cardiologists. In this case, we describe a CTO in a rare anomalous right coronary artery (RCA) that originated from a high anterior takeoff with downward direction; transradial recanalization was the second attempt at RCA CTO and was successfully performed by employing a double-anchoring technique with an antegrade and retrograde approach.