Sixteen critically ill atherosclerotic cardiac patients required intra-aortic balloon counterpulsation (IABP) for uncontrollable chest pain, hypotension or shock in connection with percutaneous transluminal coronary angioplasty (PTCA). 1.75 coronary artery angioplasty/patient were attempted. An angiographic and an immediate clinical success was achieved in 27 out of 28 attempts (96% primary success rate). All patients received heparin and antiplatelet agents. After PTCA, haemodynamic stabilization was achieved and IABP support was stopped in 14 to 96 hours. The percutaneous therapeutic procedures were well tolerated. Three patients died: one of cerebrovascular accident not related to cardiovascular problems, two other patients died suddenly 1 and 3 months later. Two patients required coronary bypass surgery, one a repeated angioplasty on a reoccluded left anterior descending saphenous vein bypass. 12 of the 13 survivors are asymptomatic after a 15-months follow-up period. IABP is a useful adjunct to PTCA in patients with severely damaged coronary circulation and compromised haemodynamics.