Heart disease is an escalating problem among women. One-third of adult females are suffering from cardiovascular disease (CVD), with at least one death per minute attributed to CVD [ ]. Initial results found that women outlive men, experience fewer signs of CVD, and experience a later onset by 10 to 20 years in the development of atherosclerotic CVD events compared with men [ ]. As women age increase through menopause, the gender difference will not be existed, and ultimately CVD becomes the leading cause of death in women as well as men. There is a definitive need to address the issue of CVD in women [ , ]. Over the past decade, despite the fact that the disparity of outcomes in women is increasingly recognized, there hasn't really been much of a change. Much has been recently reported regarding gender disparities in CVD including acute coronary syndrome, percutaneous coronary intervention (PCI) and the negative outcomes that result for women [ ]. Chronic total occlusions (CTO) are an important and increasingly recognized subgroup of coronary lesions, documented in at least 30%, but up to 52% of patients with coronary artery disease (CAD) undergoing coronary angiography [ , ]. CTO PCI is increasingly pursued, with excellent success rates and lower complication rates in real world clinical practice. It is known that sex differences exist in the presentation of CAD, as well as in clinical outcomes following routine PCI; however, it is not well described how these differences pertain to management of CTO. Women may be particularly vulnerable to treatment variability based on differences in clinical presentation and procedural complexity. No systematic review or meta-analysis has been done to address PCI procedure success rate and adverse outcomes in CTO patients between male and female populations.