Coronary dissection and acute occlusion are serious complications of coronary angioplasty and may require emergency coronary bypass surgery or result in myocardial infarction or death of the patient. Recently, perfusion balloon catheters allowing prolonged inflations have been used to restore coronary flow after major dissection and occlusion of the artery. Forty-two consecutive patients requiring this procedure were evaluated at short and long term. A satisfactory angiographic result and clinical stabilisation were obtained in 37 cases (88%). Of the 5 immediate failures, 3 (7.1%) underwent coronary bypass surgery and 2 (4.8%) were treated conservatively. Reocclusion was observed in 4 patients (9.5%) during the hospital period; 2 underwent coronary stenting (4.8%) and the other 2 were treated medically. Myocardial infarction was observed in 11 patients (26.2%). Angiographic control was performed 6.2 +/- 3.6 months later in 20 of the 33 patients with no in-hospital complications. Coronary restenosis was observed in 12 of these cases (60%). This study shows the efficacy of perfusion balloon catheter in treating major coronary dissection and coronary occlusion during coronary angioplasty. In particular, the need for emergency coronary bypass surgery was limited. However, there was a high long-term restenosis rate which emphasises the need for careful follow-up of these patients.