The treatment of chronic total occlusion (CTO) of coronary arteries is a challenge for physicians. In recent years, CTO treatment with percutaneous coronary intervention (PCI) has increased with procedural success rates as high as 70% [1]. However, CTO-PCI treatment is questionable as a recent presentation of the DECISION-CTO trial demonstrated no clinical outcome benefit over maximum medical therapy. In contrast, the EURO-CTO trail demonstrated improved health status and functional class as compared to medical management.