Abstract: Coronary flow limitation during high risk angioplasty in acute coronary syndrome (ACS) patients is an important problem, connecting with inadequate myocardial protection during the coronary intervention. Aim: was to compare intraoperative cardiohemodynamic in ACS patients during the high risk angioplasty of difficult stenoses in anterior heart arteries with- or without a coronary venous retroperfusion support. Methods: intervention results of 14 ACS patients were analyzed. In 1st group there were 6 patients (42,9%) with intraoperative myocardial retroperfusion support. In 2nd group - 8 patients (57,1%) without any intraoperative myocardial perfusion support. Results: during the retroperfusion support in the 1st group , «ST»-segment elevation at 60 sec left main (LM) or left anterior descending artery (LAD) occlusion was significantly lower (ST in V4-V6 - 1,9±1,7 mm) than in patients without retroperfusion (ST in V4-V6 - 3,1±1,7; p = 0,043). In the 2nd group, patients without coronary flow support the «ST»-segment elevation at 60 sec LM or LAD occlusion was significantly higher (ST в V4-V6 - 2,5±0,5; p = 0,043) than at 5 sec LM or LAD occlusion. No significant differences between «ST»-segment and «T»-wave deviation in the beginning and in the end of intervention were in both groups. The same dynamics was demonstrated at the time of blood pressure indexes measurement. Conclusion: coronary venous retroperfusion is an effective method of coronary flow support during the high risk angioplasty in ACS patients. Retroperfusion technology had no influence on cardiohemodynamic, but reduced the risk of intraoperative adverse cardiac events. References 1. Antman E.M., Anbe D.T., Armstrong P.W. et al. 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