Background. Today there is no clear recommendations regarding the choice of a technique for coronary chronic total occlusion recanalization.Aim. The article aims to evaluate the efficacy of choosing the coronary chronic total occlusion primary recanalization strategy according to the CHOICE score in comparison with primary antegrade recanalization.Methods. This prospective single-center study included 160 patients with chronic total occlusion. The patients were randomized into two groups: in the first, the recanalization strategy was selected on the basis of the previously developed CHOICE score, in the second, antegrade recanalization technique was used as the primary strategy.Results. In the group where the choice of primary recanalization strategy was based on the CHOICE score, technical and procedural success rates were 90% and 88.8% and were significantly higher compared to those in the primary antegrade recanalization group, 76.3% and 75%, respectively. The success rate of the primary recanalization strategy was also higher in the group where choice of the primary recanalization strategy was based on the score (80% vs. 58.8%). At the hospital stage, 2 complications were recorded, one in each group. Thus, a patient in the CHOICE score-based strategy group developed periprocedural myocardial infarction, while the primary antegrade recanalization group there was 1 case complicated by perforation of the coronary artery, which required pericardiocentesis. The average number of stents and contrast did not differ between groups. However, the intervention time was longer in the group with primary antegrade recanalization (47.6 ± 28.2 vs. 39.2 ± 23.4).Conclusion. Selecting the CHOICE score-based recanalization can significantly increase the probability of procedural success and reduce the intervention time. Received 17 October 2018. Revised 13 December 2018. Accepted 18 December 2018. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest.