Radial approach is the emerging arterial access for percutaneous coronary interventions (PCIs) in patients with coronary artery disease. Among the different subset of complex targets for PCI, chronic total occlusion (CTO) still represent a challenge for the interventional cardiologist. Is radial approach suitable for PCI on CTO? A series of data collected in selected centers with high volume of transradial procedures supported the change from elective transfemoral approach to systematic transradial approach. In this paper, we tried to provide an update on the technical aspects and the theoretical data which may be useful during the planning of CTO procedures. Overall, a full knowledge of upper limb vascular anatomy, arterial sheaths/guiding catheters selections, transradial PCI technique and CTO lesion management skill is pivotal to safely offer CTO patients the potential benefit of reduced bleeding risks through radial access adoption.