This retrospective study examined the utilization of coronary stent placement versus PTCA in hemodialysis patients with obstructive coronary disease. Prior studies have demonstrated suboptimal results with PTCA owing primarily to high rates of restenosis. We identified 19 hemodialysis patients who received a percutaneous coronary intervention who were matched with individuals without renal failure undergoing same vessel revascularization. Our study found that 71% of hemodialysis patients receiving PTCA had a recurrent cardiac event defined by subsequent angina, myocardial infarction, or cardiac death. At follow-up, 30% of patients who received stent placement had recurrent cardiac events. Intracoronary stent placement is both safe and feasible and produces more favorable clinical outcomes in the management of coronary disease in hemodialysis patients.