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Background Totally radial access (TRA) is getting popular in coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI).but it has been associated with a non-negligible risk of complications.Methods This retrospective study included 1760 CTO patients underwent PCI from January 2015 to January 2018.Patients were divided into two groups:TRA group was referred to single radial or double radial access;Femoral access (FA) group was referred to single FA,double FA,FA and RA.The primary efficacy endpoint was procedural success,which was defined as technical success without in-hospital MACE.The primary safety endpoint was a composite of vascular complications and major bleeding.Results TRA was applied in 482 cases,while FA in 1278 cases.Mean J-CTO scores was higher in FA group (2.5±1.0 vs.2.0±0.9,P=0.001).Procedural success showed no significant difference between both groups (82.9％ vs.83.6％,P=0.823).The primary safety endpoint was higher in FA group (11.4 vs.4.1％,P＜0.001).On multivariate analysis,FA approach was independently associated with the primary safety endpoint [odds ratio;(OR) 2.887,95％ confidence interval (CI) 1.759-4.739,P--0.001],after adjusting for age,diabetes,body mass index,prior CABG,and J-CTO score.Conclusions TRA for CTO PCI might be associated with lower incidence of a composite endpoint of vascular complications and major bleeding,while maintaining similarly high success rates.