Chronic total occlusions (CTO) are a common entity in patients with stable coronary artery disease undergoing coronary angiography with a point-prevalence between 15 and 30% [1–3]. CTO revascularization by PCI remains a challenge for the interventional cardiology as it requires special training, risky crossing techniques and special equipment. Therefore it is related to a significant periprocedural risk for the patient [4,5]. Therefore it remains a challenge for the physician to allocate the best treatment strategy encompassing percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), or optimal medical therapy (OMT).
