Background: Chronic total occlusions (CTOs) in coronary arteries, affecting approximately 20% of patients with suspected coronary artery disease (CAD), pose challenges in intervention due to a lower success rate (55–80%) compared to conventional lesions (>90%). This study aimed to investigate whether multi detector computed tomography (MDCT) have an impact on the success rate of percutaneous coronary intervention (PCI) of CTO of coronary arteries. Methods: This was a prospective study included 100 patients divided into two equal groups of age from 18 -80 years age groups and of both sexes presented to radiology department, Benha university hospital and national heart institute. Results: The use of contralateral injection was significantly higher in Group I (92%) compared to Group II (60%). The success rate of the procedure was significantly higher in Group I (94%) than in Group II (80%). Group I experiencing fewer complications (8.2%) compared to Group II (40.8%). Finally, Group I having a lower mean value of serum creatinine compared to Group II.. The multivariate model revealed that a history of MI was associated with about eight times increased risk of failure. The use of CT preprocedural was associated with 86.4% risk reduction of failure. Conclusion: Computed Tomography Coronary Angiography (CTCA) has facilitated the diagnosis of CAD by enabling accurate assessment of the anatomical features without the need for an invasive procedure. CTCA has its uses during the various steps of CTO PCI, starting from the initial diagnosis, followed by pre-interventional planning, and finally, post-procedure outcome and follow-up.