Sekiguchi M, et al. - By analyzing 4,053 consecutive chronic total occlusion (CTO)-percutaneous coronary interventions (PCIs) (mean age: 66.8 ± 10.9 years; male: 85.6%; Japanese CTO [J-CTO] score: 1.92 ± 1.15) in the Japanese CTO-PCI Expert Registry, researchers investigated strategies for reattempted PCIs for CTOs by highly skilled operators following a failed attempt. In reattempt CTO-PCIs, the frequent use of parallel wire technique, intravascular ultrasound guide crossing, and bidirectional approach technique was reported. Compared to first-attempt CTO-PCIs, reattempt CTO-PCIs were associated with a lower technical success rate. However, an improved success rate of reattempt CTO-PCI could be achieved by the use of more complex strategies by highly skilled operators.