Coronary artery bypass surgery and angioplasty provide symptomatic relief in patients with ischemic heart disease, but despite advancement in technique and devices, these methods are not applicable in a subset of patients with angina refractory to medical treatment. Bypass surgery may not be feasible because of lack of suitable conduits, diffuse coronary artery disease or poor distal run-off, and coronary angioplasty is sometimes not applicable due to chronic total occlusion, diffuse disease or extreme tortuosity. Transmyocardial laser revascularization and the stimulation of neoangiogenesis by a variety of growth factors have recently emerged as a new tool in the management of these patients. In the first part of this article, we review laser-induced direct myocardial revascularization, its indications, potential risks, and published clinical trials. The induction of neoangiogenesis using different growth factors or the genes encoding for them will be the subject of the second part of our review.