Coronary chronic total occlusion (CTO) is a frequent finding in patients with coronary artery
disease. It remains one of the most challenging subsets, accounting for 10-20% of all percutaneous
coronary interventions (PCI). Although remarkable progress in PCI has been made, it is reasonable
to state that successful recanalization of CTO represents the “last frontier" of PCI. PCI of CTOs
has been limited historically by technical success rates of 50-70%. The introduction of enhanced
guidewires, microcatheter, channel dilatator with increasing operator experience, and innovative techniques
such as the retrograde approach have raised hopes for better outcomes. This article goes into
depth into various strategies of retrograde approach in CTO.