Xenogiannis I, et al. - Researchers used a contemporary multicenter chronic total occlusion (CTO) percutaneous coronary intervention (PCI) registry to compare the clinical and procedural characteristics and outcomes of CTO PCIs performed with or without atherectomy. A total of 3,607 CTO PCIs conducted at 21 participating centers between 2012 and 2018 were included, with atherectomy done in 117 (3.2%) cases: rotational atherectomy in 105 cases, orbital atherectomy in 8, and both in 4 cases. Overall, atherectomy was performed in approximately 3% of CTO PCI cases currently. Older patients (68 ± 8 vs 64 ± 10 years), having higher J-CTO score (3.0±1.2 vs 2.4±1.3), were the ones on whom atherectomy was performed. Findings highlighted similar technical (91% vs 87%) and procedural (90% vs 85%) success and major in-hospital complication (MACE) (4% vs 3%) rates for CTO PCI cases in which atherectomy was used, however, atherectomy was associated with higher risk for donor vessel injury and tamponade.