A chronic total occlusion (CTO) is considered a special coronary lesion subset for which special considerations are applied regarding the indication for revascularization and the qualification of the operator. The complexity of advanced techniques for CTO treatment carry an imminent risk of specific complications such as periprocedural myocardial enzyme leaks, higher rate of side-branch occlusions, and perforation and pericardial tamponade. Long procedures with high contrast load may lead to contrast-induced nephropathy and radiation-induced skin alterations.