AbstractBackgroundContemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) practice has received limited study.AimTo examine the contemporary CTO PCI practice.MethodsWe performed an online, anonymous, international survey of CTO PCI operators.ResultsFive hundred forty‐five CTO PCI operators and 190 interventional cardiology fellows with an interest in CTO PCI participated in this survey. Almost half were from the United States (41%), most (93%) were men, and the median h/week spent in the hospital was 58. Median annual case numbers were 205 (150−328) for PCIs and 20 (5−50) for CTO PCIs. Almost one‐fifth (17%) entered CTO cases into registries, such as PROGRESS‐CTO (55%) and EuroCTO (20%). More than one‐third worked at academic institutions (39%), 31% trained dedicated CTO fellows, and 22% proctored CTO PCI. One‐third (34%) had dedicated CTO PCI days. Most (51%) never discharged CTO patients the same day, while 17% discharged CTO patients the same day >50% of the time. After successful guidewire crossing, 38% used intravascular imaging >90% of the time. Most used CTO scores including J‐CTO (81%), PROGRESS‐CTO (35%), and PROGRESS‐CTO complications scores (30%). Coronary artery perforation was encountered within the last month by 19%. On a scale of 0−10, the median comfort levels in treating coronary artery perforation were: covered stents 8.8 (7.0−10), coil embolization 5.0 (2.1−8.5), and fat embolization 3.7 (0.6−7.3). Most (51%) participants had a complication cart/kit and 25% conducted regular complication drills with catheterization laboratory staff.ConclusionContemporary CTO PCI practices vary widely. Further research on barriers to following the guiding principles of CTO PCI may improve patient outcomes.