The goal of percutaneous coronary intervention (PCI) is to provide a safe, effective, less invasive alternative to coronary artery bypass graft surgery (CABG). When introduced by Andreas Gruentzig 25 years ago, he envisioned the procedure to be a technique that would delay the need for CABG until severe multi-vessel coronary disease was present. Over the years, technological advances in equipment and devices have improved safety as well as short and long term outcomes. This has greatly expanded the indications for the technique and allowed more arteries to be accessible to effective treatment with better patient outcomes. In addition, developments in adjuvant pharmacotherapy have further improved outcomes of percutaneous procedures. The results of many large trials in the 1990s have shown that percutaneous intervention can be equally successful when compared to the “gold standard” CABG for patients with multi-vessel coronary artery disease. Now with advances in coronary stent technology, including drug eluting stents, multi-vessel angioplasty is set to make another leap forward with further expansion of the indications and improved outcomes. Approximately two thirds of patients who require revascularisation have multi-vessel disease and two thirds of these have anatomy that is amenable to treatment by percutaneous or open heart procedures.1 Both techniques have been shown to be relatively safe and highly effective in relieving angina, and have similar mortality and myocardial infarction rates; however, all the major studies have shown fewer additional revascularisation procedures in patients who undergo open heart surgery.1 It is widely anticipated that the gap in repeat procedures may begin to close with the advent of drug eluting stents. When approaching a patient with multi-vessel coronary artery disease there are many factors that should be considered. First, these patients have a less favourable long term outcome; they have increased procedural risk, and increased procedural complexity.2 …