This document discusses the use of intravascular ultrasound (IVUS) in percutaneous coronary interventions (PCI) for chronic total occlusions (CTOs). It provides examples of how IVUS can aid in CTO procedures, including guiding wiring, assessing vessel size for balloon sizing, and optimizing stent placement. While IVUS use was associated with longer procedures, more contrast and radiation exposure, it did not negatively impact success rates or safety outcomes. IVUS may help with complex CTO cases and provide information on vessel remodeling and stent expansion to reduce risks of restenosis.