Chronic total occlusions continue to represent one of the greatest challenges to interventional cardiologists. Successful revascularization has been strongly associated with improved left ventricular function, freedom from angina and future revascularization, and in several studies increased survival.

Through new guidewires, novel devices, appropriate patient selection, and improved operator technique, success rates for recanalization of complex chronic total occlusions are increasing. The novel retrograde approach to chronic total occlusions has been introduced as an alternative route for recanalization of otherwise difficult or impossible lesions.