A total of 33 patients age 35 years or younger underwent percutaneous transluminal coronary angioplasty (PTCA) at The Cleveland Clinic Foundation between January 1981 and October 1987. Arteriography showed one-, two-, and three-vessel disease in 16, 12, and 5 patients, respectively. Twenty-four patients (73%) had functional Class 3 or 4 angina and 17 (52%) had unstable angina. PTCA was performed in one vessel each in 22 patients and in multiple vessels in 11 patients. Of 47 vessels, 44 (94%) were successfully dilated. There were no deaths, emergency bypass procedures, or myocardial infarctions during hospitalization. At a mean follow-up of 30 months, there were two late deaths, nine repeat PTCA procedures, one coronary bypass, and one nonfatal myocardial infarction. Due to the progressive nature of coronary artery disease in the young adult, PTCA appears to be a good therapeutic modality for selected patients in this age group.