Total coronary artery occlusion is the main limiting factor of non-surgical recanalization procedures. With conventional methods, recanalization of total occlusions older than 6 months has a low success rate. Low-speed rotational angioplasty (ROTACS, Osypka, Medtronic) was employed in 152 patients with chronic coronary occlusions in whom conventional guide wire techniques failed. The average success rate was 60% and, although not correlated to site of occlusion, revealed a clear correlation to the duration of the occlusion: 93% (1-3 months), 74% (4-6 months), 52% (6-12 months) and 8% (greater than 12 months). Emergency surgery was needed in 2 patients in whom an attempt was made to recanalize an occluded LAD branch. In both cases, the occlusion was located in the immediate vicinity of the main trunk of the left coronary artery. Thereafter, this anatomical situation was considered a contraindication and no further complications occurred in the subsequent 120 patients. Among the 152 patients, no deaths, no myocardial infarction and no perforation of the vessel wall occurred. Long-term results were monitored by angiography in 95% of successfully treatment patients; good results were documented in 72%.