Japanese interventional cardiologists stand out as leaders in the field of coronary chronic total occlusion (CTO) revascularization, with more than 25 years of experience in the procedure. Dr David Kandzari sits down with Drs Masahiko Ochiai and Etsuo Tsuchikane to discuss when to revascularize and when to opt for bypass surgery, teaching and training, success rates, criteria for selecting antegrade vs retrograde approaches, reasons for failure, and knowing when to halt a procedure.