We herein report a 59-year-old man with a chronic totally occluded left anterior descending artery treated by percutaneous coronary intervention via an ipsilateral intraseptal channel using an intravascular ultrasound-guided retrograde wire-crossing technique. When an antegrade approach is not feasible or fails, a retrograde approach to a chronic totally occluded lesion is reasonable. However, a retrograde approach from the contralateral coronary artery is not always feasible. We herein report that an ipsilateral intraseptal channel can serve as one route by which to perform a retrograde approach to chronic totally occluded lesions of the left anterior descending artery.