On the occasion of the 1st Sino-Japanese Friendship Interventional Cardiology Forum on Complex Angioplasty in CCT， CIT Chairman Run-Lin Gao acknowledged the honor bestowed on CIT by the presence of Doctor Takahiko Suzuki， Japan， and the co-operation of his colleagues in the light of the Japanese earthquake tragedy. The opening of the morning’s live case session was marked by a solemn moment of silence at Doctor Suzuki’s request. Although operators at the Toyohashi Heart Center performing the live case presentation reported their facility had not been directly affected by the earthquake and tsunami， some difficulties had been encountered due to devices not being delivered and some drug unavailability due to disruption to industry.
　　During the live CTO-PCI demonstration broadcast from Toyohashi Heart Center， Japan， Doctor Suzuki was quizzed and asked for opinions on CTO procedures in general. Compared to low to non-existent use of IVUS prior to CTO procedures amongst Chinese practitioners， he pointed out that IVUS was very commonly performed pre-procedure at his institution and by Japanese operators at large. Similarly， IVUS guidance during procedures was his recommendation where contra-indications did not exist. In the absence of IVUS， Doctor Suzuki suggested that the experience of the operator and choice of wire with respect to sensitivity is essential in determining the correct placement of the wire in the lumen and subintimally. In the past， his recommendation for guide wire selection would have been for Miracle wires which were relative stiff， but with strategies now favoring softer (“softer is better”)， hydrophilic properties， his recommendation has evolved for X-treme or Ultimate wires.
　　He presented  a brief outline of the history of CTO-PCI  as practiced for over 25 years now， where parallel wire techniques and IVUS-guided wiring techniques and most recently the retrograde/CART approach have made significant contributions. Currently at his center， 20% of CTO cases are handled using the retrograde approach. In retrograde wiring， a single wire can be crossed distally to proximally of the CTO lesion via a collateral channel. CART/reverse CART procedures entail subintimal tracking by a bilateral approach. CTO initial success rates at Doctor Suzuki’s center in the last year were 92.6%. When asked what factors influence the 7% fail rate， he mentioned operator experience， complicating co-morbidities and simply difficult cases with tortuous vessels making wire crossing extremely difficult were important contributors.
　　The general success rate of CTO-PCI has surpassed 90% through the improvement of devices and the development of wire crossing techniques. However， Doctor Suzuki advocates that increasing knowledge and skills training will continue to improve success rates. Nurturing the new generation of interventionalists is uppermost in his goals for the future.