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 revascularization according to contemporary knowledge. Furthermore, the current high standard revascularization techniques in dedicated CTO PCI will be discussed.