BACKGROUND: Coronary chronic total occlusions (CTO) are the most challenging lesions to treat percutaneously. Thus, consistent efforts are made to develop new approaches to treat CTO. OBJECTIVE: To explore the key points of a novel "crowbar effect" approach to improve the success rate of recanalization of CTOs. METHODS: One hundred and fifty-seven patients with CTO were treated with PCI using the regular antegrade guide wire approach. Of them, 36 patients (22.9%) showed that while the first guide wire was inserted into the CTO lesions, a small balloon had difficulty passing through the CTO lesions. For those patients, the new crowbar effect technique was used to allow the balloon to pass through the lesions. RESULTS: The coronary CTO vessels in 35 patients (97.2%) were completely opened. Coronary perforation occurred in 5 patients (13.8%). This perforation was properly treated and did not lead to serious complications. CONCLUSION: The crowbar effect technique proved successful as an alternative antegrade method for opening CTO. The procedure of this novel method is easy to accomplish and success rates are high.