Unstable angina is a serious condition with high risk of early coronary events; coronary revascularization in these patients gives good results but carries higher operative risk than in stable angina patients. Full medical therapy with antiischemic agents may be effective in controlling symptoms and preventing death and is therefore the first treatment of choice; as in stable angina, further treatment is indicated in stabilized patients according to non invasive tests results and coronary angiograms. Non responsive unstable patients have a poor outcome and are candidates for revascularization: angioplasty may be preferred in single or double vessel disease and bypass operation in multivessel disease. However, surgical revascularization in single and double vessel disease with critical proximal stenosis of a large anterior descending gives optimal results in our experience and may be the treatment of choice also in these patients. Because of the higher operative risk in multivessel disease in unstable ischemia, a combined procedure with angioplasty of the "culprit" lesion followed by full revascularization at a later time may be a more favourable option in some patients with multivessel disease.