The success rate and the safety of chronic total occlusion (CTO) revascularization has greatly improved in the last two decades thanks to the development of new dedicated guidewires, microcatheters, and new techniques and shared experience with expert operators. Tissue hardness along the occlusion, from entry to exit point, is extremely variable. It is often helpful to use various types of wire to cross the occlusion. The parallel wire technique is a very important technique, which increase the success rate of antegrade CTO percutaneous coronary intervention even in difficult cases and long lesions. Buddy wire technique may prove very helpful in CTO for advancing a balloon downward, especially in stent CTOs. Anchoring balloon technique may be used to advance the stent toward the lesion in complex instances. Today this technique is less used thanks to the development of guiding catheter extensions.