OBJECTIVE To retrospectively review the techniques and results of percutaneous transluminal angioplasty (PTA) in the supra-aortic vessels. METHODS Over a 5-year period, 112 patients underwent percutaneous treatment of 151 lesions in the innominate, subclavian, carotid, and vertebral arteries. The percutaneous technique included standard retrograde femoral artery access in the majority of patients with balloon dilation of the lesion site. In the more recently treated patients, stents were deployed for suboptimal PTA; primary stent deployment was used rarely. Symptom resolution and > 50% increase in flow were criteria necessary for a successful procedure. RESULTS In this population, 141 (93%) of 151 lesions were successfully treated. PTA achieved 100% success in stenotic lesions in the internal (n = 9) and external (n = 2) carotid; common carotid (n = 8); subclavian (n = 67); and innominate (n = 13) arteries. Ninety-two percent (36/39) of vertebral artery stenoses were successfully treated. In 13 cases of subclavian occlusion, however, only 6 (46%) were recanalized. There were 3 periprocedural complications, but only 1 was major; a focal stroke manifesting as right arm weakness occurred in a patient with left common carotid PTA and stenting. Five cases of reocclusion have been seen in 5 years of follow-up. All occurred in the subclavian artery, and 3 of the 5 were in arteries originally occluded. CONCLUSIONS Brachiocephalic PTA can achieve excellent immediate and long-term results in proximal stenoses. Subclavian occlusions do not respond well to PTA, and those successfully recanalized have a high restenosis rate (50%). PTA of the arch vessel branches, particularly the vertebral artery, should be attempted only by experienced interventionists. Atherosclerotic lesions in the internal carotid arteries are best treated with endarterectomy at present, but fibromuscular dysplasia in the carotid arteries is an appropriate indication for PTA therapy.