Chronic coronary total occlusions (CTO) are diagnosed in up to 20% of patients with coronary artery disease and have a detrimental effect on patients' quality of life and long-term prognosis. The exponential developments in CTO percutaneous coronary intervention (PCI) equipment, recanalization techniques, and operator expertise have been merged into the hybrid approach that represents a percutaneous revascularization algorithm for treating CTOs and has led to technical success over 90% at experienced centers. Therefore, patient selection for CTO PCI should be focused on anticipated patient benefit in terms of health status and long-term prognosis rather than coronary anatomic complexity. Table of contents: This review will provide an overview of the clinical presentation and characteristics of patients with a CTO and will discuss the essential needs toward judicious patient selection for percutaneous CTO revascu- larization according to contemporary knowledge. Furthermore, the current high standard revascularization tech- niques in dedicated CTO PCI will be discussed.