Background Data on retrograde recanalization of epicardial collateral channels in patients with chronic total occlusion (CTO) undergoing percutaneous coronary intervention (PCI) are limited.Fearing about the complications of perforation,few CTO patients have chosen retrograde recanalization of epicardial collateral channels.Methods A retrospective analysis was conducted in this study.We followed up eligible patients who underwent continuous CTO via epicardial CCS from August 2011 to October 2018 in our center,and analyzed the detailed clinical baseline and angiographic data,surgical success rate and hospital complications to determine the efficacy and safety.The Cox model was used to compare major adverse cardiac events (MACE) and related co-variables between CTO patients with epicardial CCS perforation and non-perforated PCI patients.Results The study enrolled 191 patients with epicardial CCs PCI of CTO and the long term follow-up time was 24.03±19.18 months.Successful CCs PCI of CTO was achieved in 161 (84.8 ％) patients.Procedural collateral perforation occurred in 23 (12.0％) patients.MACEs occurred in 18 patients (9.4％) at 1-year follow-up.Kaplan-Meier curves showed no significant difference in MACEs between perforating recanalization of CCs PCI of CTO and non-perforating PCI of CTO.(adjusted hazard ratios (HR):0.467;95％ confidence intervals (CI):0.13 to 1.69,P=0.245).The multivariate Cox regression analysis identified the Weer score=0/1 (HR:5.80;95％ CI:1.89 to 17.8;P=0.002) as significant independent predictors of perforation of CCs PCI of CTO.Conclusions The major complication of the procedure is collateral perforation.Recanalization of CTOs through epicardial collateral channel is safe and effecrive.It may be a available choice for recanalization of complex CTO.