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Pitrelli has been a core member of the group since their first album. As well as being the main lead guitarist, he is also the live musical director. TSO's 2007 tour program credits his "edgy playing and vast musical lexicon" with making him a perfect fit for the band's constant boundary-pushing progressive rock stylings. Pitrelli's leads are notable on "Tracers" and the instrumental "Toccatta – Carpimus Nocten", the latter being a piece he co-wrote. Both songs form part of the group's fifth rock opera, on their 2009 album Night Castle.

Pitrelli was a member of Megadeth from 2000–02, replacing Marty Friedman. Megadeth bandleader Dave Mustaine asked him to join after hearing good reviews from their then-current drummer Jimmy DeGrasso, with whom Pitrelli played during his days with Alice Cooper in the early 1990s. Pitrelli joined the band after an impromptu "audition" in front of a live crowd in Vancouver on January 16, 2000. Two nights after Friedman played his last show with Megadeth, Pitrelli was asked to play fifteen minutes before the show and was shocked by the prospect as they never rehearsed. He was present during the recording of Rude Awakening, a live CD/DVD that was released in 2002. Pitrelli performed on their 2001 album The World Needs a Hero, which has 2 songs co-written by Pitrelli and he played most of the guitar solos. When Megadeth entered hiatus after Mustaine injured his arm, Pitrelli rejoined Savatage on April 9, 2002, but did not tour with the band. He also continued his work with TSO, which he's still a member of today.

In 1998, Pitrelli was featured on the video game album Sonic Adventure Remix, where he played guitar on a remix of the game's theme song "Open Your Heart".

Al joined Savatage in 1995, joining at the same time as Chris Caffery returned to the band; Caffery had previously been part of the band around the release of Gutter Ballet in 1989. Pitrelli played guitar on the albums Dead Winter Dead (1995) and The Wake of Magellan (1997), and performed some lead guitar work on Poets and Madmen (2001), despite being a member of Megadeth at the time. On that album, Pitrelli was responsible for the outro of "Stay with Me a While", the main solos of "Morphine Child" and "The Rumor", the first part of the main solo in "Commissar" and its outro. During his time with Savatage, he was asked by their producer Paul O'Neill if he was interested in joining his side project, the Trans-Siberian Orchestra. Pitrelli agreed and has played a role in all of their albums to date.

Pitrelli attended the Berklee College of Music in Boston in the early 1980s (where keyboardist Derek Sherinian was his dorm roommate; they would later work together in the Alice Cooper band). While at Berklee, Al formed an original 1980s metal band with classmates that included Venom guitarist Mike Hickey. After dropping out of Berklee, Pitrelli worked as a session musician during his early days, and also taught guitar lessons in Manhattan, and in Bellmore, Long Island. His first major label gig was performing with Michael Bolton, helping him support his single "Fool's Game". Pitrelli said of the single, "This was when Michael Bolton was still trying to be Sammy Hagar and not Engelbert Humperdinck."

In the late 1980s/early 1990s, Pitrelli joined forces with bassist Randy Coven and drummer John Reilly to release two Shrapnel Records-type albums titled "Sammy Says Ouch" and "CPR". Pitrelli was Alice Cooper's guitarist and musical director from 1989 until 1991 on the Trashes The World tour. He then joined Dee Snider's band Widowmaker for two albums in the early/mid–1990s, and also briefly played with Stephen Pearcy (from the band Ratt) in a band called Vertex. Pitrelli also joined Asia, appearing on their albums Aqua (1992) and Aria (1994). He would go on to be featured on many New York sessions, including for Kathy Troccoli, Taylor Dayne, Randy Coven and Exposé. His songs have been covered by Y&T, Lita Ford and Derek Sherinian. For a month he substituted in Blue Öyster Cult. Widowmaker (w/ Dee Snider) albums "Blood & Bullets" (1994) & "Standby For Pain" (1995)

Al Pitrelli (born September 26, 1962) is an American guitarist, best known for his work with the Trans-Siberian Orchestra, Megadeth, Alice Cooper, Joe Lynn Turner, Asia and Savatage.