A 65-year-old man with unstable angina had a critical left anterior descending coronary artery stenosis which progressed to total occlusion, without evidence of acute myocardial infarction. Thallium imaging revealed defects in the distribution of the left anterior descending coronary artery on exercise and redistribution, 4h later. <sup>99m</sup>Tc radionuclide angiography showed a fall in left ventricular ejection fraction on exercise, and contrast cineangiography showed an extensive area of akinesia. Percutaneous transluminal coronary angioplasty was successful without any complications. Repeat radionuclide studies demonstrated improvement of both myocardial perfusion and function. Angiography at 1 year showed normal left ventricular contraction and no evidence of recurrent stenosis. The patient is free of angina, on no medication 2 years after angioplasty. This case illustrates the feasibility of myocardial salvage by elective coronary angioplasty in patients with unstable angina total coronary occlusion.