Objective To investigate the feasibility of retrograde percutaneous intervention in treatment of coronary chronic total occlusion (CTO) in the elderly. Methods All patients who undergoing retrograde percutaneous recanalization for coronary CTO in our hospital from January 2004 to May 2015 were enrolled in this study. They were divided into the elderly group (n＝119, ≥60 years old) and the non-elderly group (n＝136, ＜60 years old). Successful rate of retrograde PCI, efficacy and incidence of complications were compared and analyzed between the 2 groups. Results The elderly group had more comorbidities, such as hypertension, diabetes, cerebrovascular diseases (all P＜0.05), and higher score of European system for cardiac operative risk evaluation (EuroSCORE, P＜0.001) than in the non-elderly group. There were more patients having double and triple vessel coronary artery diseases in the former than in the latter group (both P＝0.000). While, the incidence of single-vessel disease was lower in the elderly group than in the non-elderly group (P＝0.000). The SYNTAX scores were higher in the former than in the latter group, with significant differences (P＜0.001). The proportion of patients having CTO for 3 to 12 months was significantly larger in the non-elderly group than in the elderly one, while that of those having CTO for 6 to 9 years or longer than 9 years was larger in the elderly group (both P＝0.000). Conclusion Retrograde percutaneous recanalization is a safe and effective approach for coronary CTO in the elderly.