Anisotropy is a common phenomenon in subsurface strata and should be considered in seismic imaging and inversion. Seismic imaging in a vertical transversely isotropic (VTI) medium does not take into account the effects of the tilt angles, which can lead to degraded migrated images in areas with strong anisotropy. To correct such waveform distortion, reduce related image artifacts, and improve migration resolution, a tilted transversely isotropic (TTI) least-squares reverse time migration (LSRTM) method is presented. In the LSRTM, a pure qP-wave equation is used and solved with the finite-difference method. We have analyzed the stability condition for the pure qP-wave equation using the matrix method, which is used to ensure the stability of wave propagation in the TTI medium. Based on this wave equation, we derive a corresponding demigration (Born modeling) and adjoint migration operators to implement TTI LSRTM. Numerical tests on the synthetic data show the advantages of TTI LSRTM over VTI RTM and VTI LSRTM when the recorded data contain strong effects caused by large tilt angles. Our numerical experiments illustrate that the sensitivity of the adopted TTI LSRTM to the migration velocity errors is much higher than that to the anisotropic parameters (including epsilon, delta, and tilted angle parameters), and its sensitivity to the epsilon model and tilt angle is higher than that to the delta model.