Background: Chronic total occlusions (CTO) represent a continuously increasing lesion subset in contemporary angioplasty practice, which is observed in about 15% of patients undergoing coronary angiography with a higher prevalence in those with previous coronary artery bypass grafting (CABG). Objective:  To determine the impact of lesion age on procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Patients and methods: Sixty six patients with CTO having significant angina or recent acceleration of previously chronic stable angina, admitted to National Heart Institute and Zagazig University Hospitals were included in this cohort study to determine the impact of lesion age on procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). According to the CTO age, our study population was subdivided into 3 groups: group 1 (CTO age of > than 3 to 12 months), group 2 (CTO age of 12 to 24 months) and group 3 (CTO age of >24 months). All patients were subjected to PCI for coronary chronic total occlusion. Results: There was statistically significant relation between the studied groups regarding gender. Within the group with CTO from 3 to 12 months, 54.5% were females versus 22.7% and 18.2% within the groups of 12 to 24 and >24 months respectively. There was statistically significant relation between time for PCI and time of CTO. On doing Turkey HSD test, the difference was significant between 3 to 12 months and each other group (as in this group, time of PCI was significantly the lowest time).  Conclusion: Success of CTO - PCI in the current era of new dedicated CTO equipment is unlikely to be affected by CTO lesion age.