Abstract: Chronic total occlusion (CTO) is the difficult point for percutaneous coronary intervention (PCI). Because of its special pathological basis, the patient's requirements are very high, the operation success rate is low, and the complication rate is high. Perioperative myocardial injury (PMI) is a complication of CTO-PCI. Compared with non-occlusive lesions, CTO-PCI can lead to PMI when it involves larger branch vessels and collateral vessels. This article reviews the causes, prevention and treatment progress of PMI associated with CTO-PCI.