Chronic total occlusions (CTO) occur in 15-30% of coronary angiogram, yet this challenging lesion subset represents less than 10% of percutaneous coronary interventions (PCI). [cite: 69] Tunisian data are lacking. This study analyses a real-life Tunisian CTO-PCI immediate and long-term results. [cite: 70] Methods: Single-center, observational retro-prospective study, between 2018 and 2023. Primary endpoint was to assess technical success, major procedural complications, and target lesion failure (TLF) at 12-months. [cite: 71] Secondary endpoint was to identify factors associated to technical failure. [cite: 72] Results: 115 patients, 122 CTOs lesions, 133 CTO-PCIs. Mean age 62±14.4 years. Gender-Ratio=6. Mean J-CTO score was 1.47±1.12. [cite: 73] Dual injection (43.6%) and microcatheters (50.4%) were underused. Number of guidewires per procedure was 2.35±1.12. [cite: 74] Anterograde, retrograde and hybrid approaches were noted in 85%, 9% and 6%, respectively. [cite: 75] Technical success was 69.2% (of 133 procedures) and procedural success was 73.0% (of 115 patients). [cite: 76] Major complication rate stood at 3%. At 12 months, cardiovascular mortality was 7.0%, without difference according to procedural success. [cite: 77] TLF was 9.4% among successful CTO-PCIs. Associated factors to technical failure were bifurcation involvement (OR=5.83 [1.7-20.1]; p=0.005), use of more than 4 guidewires per-procedure (OR=6.83 [1.6-28.7]; p=0.009), de-novo CTO (HR=8.43 [1.9-36.6]; p=0.004), previous attempts (OR=8.87 [1.8-43.6]; p=0.007), and no microcatheter use (OR=11.4 [3.5-36.8]; p=0.001). [cite: 78] Conclusion: This real-life study fills a gap in Tunisian data on CTO-PCI outcomes with technical success, complications and TLF rates comparable to those reported in literature. [cite: 79] 12-month survival rates were similar between successful and failed procedure groups. [cite: 80].