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Background The use of collateral channels(CCs)in crossing the occlusion plays a pivotal role in the retro-grade PCI approach,but the impact of septal collateral distal tip injection(DTI)on contemporary septal collateral channels(CCs)crossing is still unknown.Methods 264 chronic total occlusion(CTO)cases in which the retro-grade approach via septal collateral channels were enrolled after reviewing the coronary angiograms of 1300 pa-tients from Jan 2014 to Dec 2019.This study collected the clinical and angiography data of those patents for ana-lyzing the usefulness of this technology.In addition,a forward multivariable logistic-regression model was ap-plied to identify the independent predictors of CC crossing failure.Results A total of 264 retrograde cases were divided into successful CCs crossing group(n=233,88.3％)and failure group(n=31,11.7％).Univariate statistics showed successful cases had low proportion of collateral channel tortuosity(42.1％vs.67.7％,P=0.011)and J-CTO ≥3 lesions(68.7％vs.90.3％,P=0.002)while had higher proportion of Werner CC2 collateral(52.8％vs.16.1％,P＜0.001).Multivariate statistics found that the use of DTI was not significantly associated with increas-ing CCs crossing success rate.Twenty cases in success group performed DTI after CCs crossing failure.Conclu-sions Successful CTO PCI via septal CCs was not enhanced by the use of DTI before CCs attempt.