Abstract : Coronary artery disease (CAD) is a primary contributor to cardiovascular disease burden, with India having about 29.8 million CAD cases in a population of 1.03 billion, a 3% prevalence. Chronic Total Occlusion (CTO) poses challenges for cardiologists due to complexities, leading to lower success rates compared to non-occluded artery procedures. This prospective observational study aimed to analyze the clinical, risk factors, and echocardiographic profiles of patients with coronary chronic total occlusions (CTOs). It examined angiographic details, quantified disease severity using the SYNTAX score, and assessed technical challenges with the J-CTO score. The research also investigated management patterns and outcomes for CTO patients. Among the 66 enrolled CTO patients, the majority (89%) were males with an average age of 56. Most (72%) had angina class II or higher, and common comorbidities included hypertension (54%) and diabetes (39%). Approximately 82% had multivessel coronary artery disease (CAD), with nearly 80% having SYNTAX scores ≥23. The right coronary artery (RCA) was frequently involved. Percutaneous coronary intervention (PCI) was performed in 57% of cases, while 30% underwent coronary artery bypass grafting (CABG), and 12% received medical management. The predominant CTO-PCI technique was antegrade wire escalation, with polymer-jacketed wires like Fielder XT-A and GAIA II being commonly used. After a three-month follow-up, patients in the revascularization group reported symptom improvement. Notably, male gender, RCA territory CTO, a JCTO score of ≤1, and a SYNTAX score <31.5 were significant predictors of successful PCI outcomes. This study provides valuable insights into coronary CTOs, highlighting factors that influence revascularization success. It suggests potential benefits of intervention within three months in the context of interventional cardiology at a high-volume center in western India. The combined use of J-CTO and SYNTAX scoring systems is recommended for predicting procedural outcomes and technical challenges during PCI.