Endovascular recanalization in patients with carotid chronic total occlusion (CTO) has been reported to be technically challenging. In this study, we retrospectively analyzed the 3D vessel wall imaging in patients with carotid CTO and its relationship to technical success rates. A total of 15 consecutive carotid CTO recanalization attempts were performed with overall technical success rate 60.0%. Compared with failure group, patients with an occlusion length <50mm, distal true lumen visibility in C1 segment on MR vessel wall images had a higher rate of successful recanalization. 3D vessel wall MR imaging may play a role in patient selection of endovascular recanalization in patients with carotid CTOs.