Antegrade techniques are the foundation of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Antegrade wiring with the intent to achieve an intraplaque guidewire tracking is not always feasible, and crossing into the extraplaque space with subsequent reentry (antegrade dissection and reentry), might be needed, particularly in more complex occlusions. The present article reviews in detail the antegrade approaches to CTO PCI, focusing on equipment, techniques, and overcoming challenges.