AbstractThe relief of coronary obstruction by surgical grafting was the first effective treatment to be directed at the cause of ischemic heart disease. PTCA represents the second major step in relieving coronary stenosis. It seems timely to review where this second step has led in order to understand how percutaneous transluminal coronary angioplasty (PTCA) relates to surgery and to understand future implications of this procedure.This review will reflect many of the authors biases and prejudices derived from their experience at Mayo Clinic.1It will also be a somewhat practical assessment. Such a pragmatic approach can be defended because PTCA itself is built on pragmatism. It is more of the world of craftsmen than of the world of scientists. We are still waiting for science to “catch up” to help solve important remaining problems such as the issue of acute rethrombosis and restenosis.Our ability to review the Mayo Clinic experience is made possible only by having a dedicated team of colleagues in the catheterization laboratory and a dedicated support group managing our PTCA Registry. Experience with other large registries (the NHLBI CASS Registry and the PTCA Registry) has taught us that this is a valuable method of collecting and reviewing the experience with a new procedure as it develops. This approach is likely to be more widely applied in the fut