Aim To investigate the incidence and predictive factors of unsuccessful operation after successful guide wire and microcatheter routing in reverse interventional therapy for chronic total occlusion (CTO) of coronary artery.Methods 310 patients with coronary CTO treated with reverse interventional therapy were analyzed by retrospective analysis. After the guide wire and microcatheter were successfully traced, according to whether the final operation was successful or not, the patients were divided into two groups:success group (n＝278), failure group (n＝32). The differences of clinical data were analyzed between the two groups. Univariate and multivariate analysis were used to explore the related and predictive factors of surgical failure. Results 10.3% (32/310) of the patients failed in the operation after the success of guide wire and microcatheter routing. The CC0-1 grade of Werner collateral circulation, calcification of lesion vessel, lesion length＞20 mm, operation time, contrast agent dosage and X-ray exposure dose in failure group were significantly higher than those in success group (P＜0.05). Univariate analysis showed that calcification of lesion vessel, lesion length＞20 mm and tortuous collateral vessel were associated with failure of reverse interventional therapy (P＜0.05). Multivariate analysis showed that calcification of lesion vessel was an independent predictive factor of reverse interventional therapy failure (P＜0.05). Conclusions Reverse interventional therapy has a high success rate, and the main predictor of failure is coronary vascular calcification. Improving the treatment strategy and instrument of calcified vessels can increase the success rate of reverse interventional therapy.