Patients with diffuse coronary artery disease present a significant management problem. It has been proposed that diffuse coronary disease is unsuitable for balloon angioplasty and surgical treatment is not ideal either. We review the evidence that coronary balloon angioplasty is not a suitable treatment for diffuse coronary disease and examine the role of alternative interventional techniques. New techniques including long angioplasty balloon catheters and atherectomy devices have shown promise. If this is confirmed by prospective randomized trials then coronary angioplasty may yet prove an attractive treatment for diffuse coronary disease.