Zivelonghi C, et al. - In this post-hoc sub-analysis from the randomized PRISON-IV trial, researchers assessed the angiographic and clinical outcome of patients treated with retrograde techniques. Based on the first technical approach, namely antegrade (n = 285) or retrograde approach (n = 45), they divided the participants (330 patients with a successfully recanalized chronic total occlusion (CTO) lesion randomized 1:1 to receive either hybrid-SES or EES). Findings revealed similar demographic characteristics between the two groups. In the group treated with retrograde techniques, higher CTO lesion complexity was suggested by angiographic features, with longer occlusions and longer stented segment. A non-significantly higher target-lesions revascularization rate was observed in the retrograde group during clinical follow-up at 12-months. Overall, the benefits of retrograde techniques in CTO revascularization were supported and late follow-up revealed non-significant differences in angiographic and clinical outcomes.