Skin injuries may occur when radiation doses to the skin exceed 2 Gy. This study aimed to measure changes in skin microcirculation in patients undergoing chronic total occlusion percutaneous coronary interventions (CTO-PCI). In 14 patients, peak skin dose (PSD) was estimated with radiographic films and skin microcirculation was assessed with laser speckle contrast imaging (LSCI), before, 1 day after the intervention, and 4–6 weeks later. The mean PSD was 1.8 ± 0.9 Gy. Peak skin microcirculation increased by 12% from 45 ± 6 PU before to 50 ± 9 PU 1 day after the intervention (p = 0.01), and returned to 46 ± 8 PU after 4–6 weeks (p = 0.15). There was no significant correlation between PSD and the change in perfusion, neither 1 day (r = −0.13, p = 0.69) nor 4–6 weeks after the intervention (r = 0.33, p = 0.35). These results suggest that there are no radiation-induced microvascular changes in the skin after CTO-PCI at skin doses below 2 Gy.