Below is a list of contraindications and limitations for angioplasty.
1. A totally blocked artery cannot be cleared because the catheter cannot be positioned, and chronic total
occlusions are present in more than 20% of patients and are particularly frequent in patients with multi-vessel disease.
2. Disease of the left main coronary artery before it divides into the anterior descending presents too great a risk.
3. The obstruction is in the terminal part of the artery and cannot be reached by the balloon catheter.
4. A coronary artery bypass surgical team is not available; this is a relative contraindication; experienced operators in high-volume angiographic laboratories have low complication rates when compared with low-volume medical centers. The rare patient who requires bypass surgery because of complications can be stabilized and transported to an available surgical center. The recent availability of bail-out coronary stents has reduced the emergency CABG rate after PTCA to less than 1%.
5. Diabetics do not often obtain beneficial results; many diabetics have lesions in the coronary arteries that are irregular, diffuse, and long and not amenable to PCI. Surgery is more beneficial in most diabetics.

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