The concept of counterpulsation was introduced by Moulopoulos and colleagues in 1962 when they first described an intravascular counterpulsation balloon. Balloon counterpulsation was first employed clinically in 1968 by Kantrowitz et al. Intraaortic balloon pump (IABP) insertion originally required a femoral arteriotomy. In 1980, Bregman and Kaskel described percutaneous IABP insertion utilizing a sheath and dilators.1 Unlike the ventricular assist device (VAD) and total artificial heart, the IABP is not designed to completely replace the function of the native ventricle. Rather, the IABP functions in concert with the native heart increasing coronary arterial perfusion while reducing myocardial oxygen consumption. At the same time, the IABP provides a modest increase in systemic perfusion. The IABP is a standard form of therapy for patients with a wide variety of cardiovascular diseases. In 1993, nearly 100,000 IABPs were inserted in the United States alone.