Chronic total occlusions (CTO) are defined as complete occlusion of coronary vessel with at least a 3-month duration. Treatment options for patients with coronary CTO include lifestyle changes, pharmacologic treatment and revascularization with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). While the changes in lifestyle and pharmacologic treatment follow the guidelines of the European Society of Cardiology (ESC), the main controversy remains regarding revascularization. Because of the lack of randomised clinical data, in many cases we need to rely on our own clinical opinion. The biggest and best documented benefit of revascularization of CTO is improvement in symptoms. Other indications such as ischaemia in the area or relapsing ventricular tachycardia will be the subject of following clinical studies. In the case of proper indication, treatment and execution we could significantly improve the quality of life of these patients.