Therapeutic strategy-making and instrumental limits still remain 2 major problems that challenge the treatment of arterial chronic total occlusion (CTO) of lower extremity. Guidewire crossing-based strategy requires interventionalists to evaluate the nature of lesion at first,and then choose a right guidewire according to the characteristics of different wires. From hydrophilic coating guidewire to intraluminal tip-weighted guidewire, innovation of guidewire manufacturing may provide more appropriate options for specific lesions. With the advanced understanding of the nature of the lesion, interventionalists also began to adjust treatment strategy for different CTO lesions accordingly.This paper reviewed the previously published reports in the aspect, compared the advantages and disadvantages of various guidewires, and provided strategic suggestion for clinical treatment of arterial CTO lesion of lower extremity.