First generation drug-eluting stents (DES) had a major impact on our capacity to percutaneously treat coronary chronic total occlusions by significantly reducing the risk for in-stent restenosis compared to bare metal stents. Second generation drug-eluting stents further improved our capacity to treat these complex lesions by providing improved deliverability and enhanced efficacy and safety. The ongoing development of bioabsorbable stents will likely be the next major advancement to improve the durability of chronic total occlusion interventions.