This review confines itself to the new technologies that are widely used and that are being tested in formal trials. To date there have been few well-performed trials to compare the technologies, a fact that may have opened the way for the inappropriate use of some of these new technologies. This has allowed enthusiasts to perform procedures with as yet unproven tools no better and possibly worse than balloon angioplasty. New technologies can be broadly divided into three categories depending on their intended role: 1) mechanical removal, such as directional atherectomy, extractional atherectomy, and rotational atherectomy, that is designed to debulk lesions and remove atheromatous material, 2) high-energy removal by laser technologies designed to disobliterate lesions without producing the theoretically damaging lateral stretching of normal balloon angioplasty, 3) intraluminal scaffolding through the use of stents designed to give intravascular support, eg, balloon expandable, self-expanding, and temporary removable devices.