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In 2018, the Chronic Total Occlusion Club China (CTOCC) presented a new CTO percutaneous coronary intervention (CTO PCI) algorithm. At the end of 2020, an updated CTOCC algorithm was proposed by this group after the adoption of innovative concepts and novel techniques in CTO PCI. The updated CTOCC algorithm summarizes the contemporary CTO PCI practices in China, in which simultaneous contralateral injection and careful angiographic review, along with strategic changes, are emphasized. Additionally, we provide some new recommendations for techniques such as the “move the cap” and “active greeting” techniques and investment procedures.