Intracoronary blood flow velocity measurements with a Doppler probe and the radiographic assessment of myocardial perfusion with contrast media previously have been used to investigate regional coronary flow reserve. In the present study we applied both techniques in the same patients to measure the immediate improvement in coronary flow reserve as a result of angioplasty. In addition we compared papaverine induced hyperemia with reactive hyperemia following transient transluminal occlusion of a major coronary artery. In 13 consecutive patients with a single proximal stenosis, coronary flow reserve was measured pre‐ and postangioplasty by digital subtraction cineangiography, while pre‐ and postangioplasty Doppler measurements before and after papaverine were obtained in the proximal part of the stenotic vessel. After the last transluminal occlusion, reactive hyperemia recorded with the Doppler probe was also compared to the coronary flow reserve measurement obtained during papaverine induced hyperemia. As a result of the angioplasty, coronary flow reserve measured with the radiographic technique (mean ± SD) increased from 1.1 ± 0.4 to 2.2 ± 0.4 (P<0.001), while coronary flow reserve measured with the Doppler probe (mean ± SD) increased from 1.2 ± 0.3 to 2.4 ± 0.4 (P<0.001). Pharmacologically induced hyperemia measured with the radiographic technique and the Doppler probe were linearly related (r = 0.91 with a SEE 0.3) and confirmed the reliability of the intracoronary measurements. Using these two independent techniques, coronary flow reserve immediately after angioplasty was found to be substantially improved but still abnormal. In addition, the magnitude of hyperemia induced by papaverine was comparable to the reactive hyperemia following transluminal occlusion, although the latter measurement was recorded with the angioplasty catheter still across the dilated lesion. (J Interven Cardiol,