During percutaneous transluminal coronary angioplasty (PTCA), the ability to maintain balloon inflations for 3 to 5 minutes, as opposed to the usual 30 to 60 seconds, may lead to improved early and late results. To determine the feasibility and clarify the advantages of distal hemoperfusion during PTCA, blood from the renal vein was manually sampled and then reinjected through the pressure port of the coronary balloon catheter during sustained balloon inflations in 3 patients. By supplying the periphery of the left anterior descending coronary artery with flows of 30 to 50 ml/min, ischemic manifestations were suppressed in all 3 cases. Hemoperfusion was performed without complications for as long as 5 minutes, using a maximum of 225 ml of blood. This new technique represents a major step toward the long-sought goal of extracorporeal coronary circulation during PTCA.