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The use of 5 or 6 Fr sheath in transradial (TR) approach is often required due to the relative small radial artery size. A sheathless approach may overcome the limitation of small radial size which limits the TR approach. Our case showed successful angioplasty of the right coronary artery chronic total occlusion (CTO) by bilateral TR approaches, utilizing a 7-Fr guide (7 Fr BL 3.5, 85 cm) for a retrograde sheathless approach, and a 6-Fr Ikari 3.5 guide catheter for an antegrade approach. The sheathless TR technique can minimize vascular trauma and increase back-up support for successful coronary intervention in CTO.© 2013 Wiley Periodicals, Inc.