Background The Guidezilla reverse controlled antegrade and retrograde tracking(“Guidezilla reverse CART”)technique has become one of guidewire crossing techniques in current retrograde coronary total occlusion(CTO)percutaneous coronary intervention(PCI),but has received limited study regarding long-term outcomes.Our aim is to investigate procedural and long-term outcomes in a real-world cohort of CTO patients who underwent retro-grade PCI with the“Guidezilla reverse CART”technique.Methods Our study included 315 patients who un-derwent retrograde CTO PCI,with 86 patients treated with“Guidezilla reverse CART”technique(the Guidezilla group)at Guangdong Cardiovascular Institute from January 2015 to December 2017.The median follow-up was 1.9 years.Major adverse cardiac events(MACE)were analyzed using the Kaplan-Meier method,and indepen-dent predictors of long-term MACE were determined using a multivariable Cox model.Results Procedural suc-cess of the Guidezilla group and non-Guidezilla group were 95.3％and 82.1％,respectively(P=0.003).The proce-dural complications and in-hospital MACE were similar between both groups.During the 4-year follow-up,27 patients had MACE.Multivariable analysis revealed that the“Guidezilla reverse CART”technique was not asso-ciated with worse long-term clinical outcomes[hazard ratio(HR):2.11;95％Cl:0.64-6.98,P=0.220].Conclu-sions The“Guidezilla reverse CART”technique improves the success rate in retrograde PCI of more complex CTOs and is associated with similar complication and in-hospital MACE rates.The“Guidezilla reverse CART”technique is not significantly associated with adverse clinical outcomes.