Revascularization of chronic total occlusion (CTO) by percutaneous coronary intervention (PCI) remains a rapidly evolving frontier in the field of interventional cardiology. Development of unique techniques, devices, and strategies has incrementally improved procedural success rates, with experienced centers achieving >85–90% success [ , ]. The introduction of intravascular ultrasound (IVUS) into the armamentarium of CTO PCI is one of the advances in this field. The use of IVUS was associated with a better procedural success rate and subsequent clinical outcomes [ ]. Yet IVUS guidance may provide further advantages in CTO PCI, as shown in this issue of Cardiovascular Revascularization Medicine [ ].