Wang T, Guan H, Tian T, et al. - Researchers sought to determine the procedure success rate as well as clinical results of in‐stent restenotic chronic total occlusion (ISR‐CTO) percutaneous coronary intervention (PCI). Enrolled patients were those who received ISR‐CTO (n = 212) or de‐novo CTO (n = 2,447) PCI at Fuwai Hospital from 2010 to 2013. Experts assessed 30‐day and 5‐year clinical results. A higher rate of suboptimal recanalization was noted for ISR‐CTO PCI vs de‐novo CTO PCI. Suboptimal recanalization in ISR‐CTO PCI was predicted by syntax score prior to PCI as well as occlusion length ≥ 20 mm. In those who received ISR‐CTO PCI, higher cardiac death and 30‐day all‐cause mortality were observed. A higher rate of myocardial infarction (MI) was noted, at 5 years, in the ISR‐CTO group. Findings demonstrated higher suboptimal recanalization, 30‐day cardiac death, and long‐term MI rates for ISR‐CTO PCI vs de‐novo CTO PCI. Long‐term major adverse events following ISR‐CTO PCI were independently predicted by suboptimal recanalization.