Angiographic morphology of recurrent stenoses after percutaneous transluminal coronary angioplasty: are lesions longer at restenosis?

Abstract

Angiographic morphology was analysed in 32 patients who developed restenosis after initially successful coronary angioplasty. The mean minimal luminal diameter of the dilated coronary segments increased from 0.9 mm to 2.3 mm after dilatation, but decreased to 0.9 mm at restenosis. The reference diameter was unchanged after dilatation and at restenosis. Mean stenosis length before the initial angioplasty was 7.0 mm but at the repeat procedure had increased to 8.7 mm (mean increase 1.7 mm, 95% confidence interval 0.6 to 2.8 mm, p less than 0.01). There were no significant differences in mean trans-stenotic pressure gradient and mean eccentricity ratio between the initial and repeat angioplasty procedures. In individual patients the changes in stenosis morphology were unpredictable, but overall stenoses tended to be longer at restenosis. In some patients stenosis length increased by several millimetres but the success rate of repeat angioplasty was high and the clinical importance of the changes in stenosis morphology are uncertain.

ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention

“…(80,83,845). A number of factors have been associated with the propensity to develop stent restenosis, including small vessel size (846), smaller postprocedure minimum lumen diameter (847), higher residual percent diameter stenosis (848), lesions located in the LAD (83), stent length, and the presence of diabetes mellitus (721,841,842,844,(846)(847)(848). Stent restenosis may occur within the stent, due to intimal hyperplasia, or at the stent margins, due to both intimal hyperplasia and arterial remodeling (849).…”

ACC/AHA/SCAI Practice Guidelines, February 21, 2006

“…Some studies have suggested that lesions become longer and more severe after repeat PTCA of restenotic lesions (840,841). In a serial angiographic study, the mean stenosis length before the initial angioplasty was 7.0 mm but increased to 8.7 mm at the time of the repeat procedure (an increase of more than 1.7 mm, 95% CI 0.6 to 2.8 mm, P less than 0.01) (841).…”

“…In a serial angiographic study, the mean stenosis length before the initial angioplasty was 7.0 mm but increased to 8.7 mm at the time of the repeat procedure (an increase of more than 1.7 mm, 95% CI 0.6 to 2.8 mm, P less than 0.01) (841). A history of restenosis may also predict the risk for subsequent restenosis after PTCA of a new lesion (104).…”

“…(721,841,842,844,(846)(847)(848). Stent restenosis may occur within the stent, due to intimal hyperplasia, or at the stent margins, due to both intimal hyperplasia and arterial remodeling (849).…”