An-73-year-old male with the history of hypertension, diabetes and lower extremity artery disease was referred to our hospital because of a 2-year history of abdominal angina after each meal. Upper and lower gastrointestinal endoscopies showed no abnormal findings. CT images revealed a heavily calcified CTO in the ostium of SMA (Figure 1A and axial imaging in Supplementary Movie 1) and 3D-CT detected pancreaticoduodenal arcade with filling of the SMA from the celiac artery (Figure 1B and 1C). Angiography of the celiac artery in the front view revealed collateral blood flow supplying to the SMA; however, the pancreaticoduodenal arcade was not visualized clearly (Figure 2A and Supplementary Movie 2). According to the collateral route shown by the 3D-CT, we attempted TCA approach and retrograde wire crossing of the SMA-CTO. A 6.0-Fr Brite Tip Judkins Right4 guiding catheter (Cordis, Miami, FL, US) via the left radial artery was engaged in the ostium of the celiac artery. We proceeded the Hi-Torque Command 0.014 guidewire (Abbott Medical, Santa Clara, California, US) with Corsair microcatheter with 150 cm length (Asahi Intecc, Aichi, Japan) into the gastroduodenal artery. Jupiter SFC guidewire (Boston Scientific, MA, US) could advance into the superior pancreaticoduodenal artery and reach the distal portion of the SMA-CTO. After cannulating the microcatheter, Vassallo 14 guidewire (Cordis, Miami, FL, US) could cross the CTO (Figure 2B). A 6.0-Fr long sheath was inserted into the right common femoral artery and a 12.0-20.0 mm En-Snare (Merit Medical, Tokyo, Japan) was used to capture the Vassallo 14 guidewire, which was withdrawn through the right femoral sheath. Eagle Eye intravascular ultrasound (IVUS; Philips Volcano, Rancho Cordova, CA, US) confirmed the intraplaque wire crossing (Supplementary Movie 3). After dilatation with 6.0 mm Shiden HP balloon (Kaneka Medix, Osaka, Japan) at 20 atm (Figure 2C), two Express Vascular SD of 6.0 × 18mm (Boston Scientific) was implanted in the SMA. IVUS revealed that the stents were well expanded (Supplementary Movie 4), and angiography showed antegrade blood flow in the SMA (Figure 2D). The patient had no major post-operative complications and was discharged from the hospital. During 3 months after the EVT, the patient had no further episodes of abdominal angina on dual-anti-platelet therapy.