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Background: Chronic total occlusion is the subtype of lesions with the lowest procedural success rates, as well as the most common cause of incomplete revascularization and coronary artery bypass grafting. Their recanalization requires advanced techniques, dedicated materials, skilled operators and, usually, double arterial access, which makes the procedure more complex, increasing the chance of complications. Our goal is to characterize the most frequent complications in percutaneous treatment of chronic total occlusions in contemporary practice. Methods: We searched the PubMed/MEDLINE databases using the keywords "coronary chronic total occlusion", "complications" and "angioplasty". We followed the PRISMA recommendations. Results: Of a total of 430 references initially reviewed, 6 met the inclusion and exclusion criteria of the analysis, and accounted for the final sample. The procedural success rate was high, between 76% and 96%. The most commonly reported complications were periprocedural myocardial injury (8.6%), vascular access-related complications (2.5%), and cardiac tamponade secondary to coronary perforations (1.3%). Conclusion: Percutaneous treatment of chronic total occlusions creates a challenging scenario, with a high potential for complications. Patient selection must be focused on the anticipated benefits, and operators must be properly trained and capable of successfully conducting the procedure, recognizing and preventing potential procedural adverse events, and managing them when needed.