A thirty year old man underwent coronary angioplasty for an isolated ostial stenosis of the ostium of the right coronary artery after mediastinal radiotherapy given ten years previously. Despite an angiographically acceptable angioplasty result, he had a myocardial infarction two months later and coronary artery surgery was performed. The most effective form of myocardial revascularisation for radiotherapy related coronary artery lesions remains to be established.