Repeat coronary angioplasty

Abstract

The potential of repeat percutaneous transluminal coronary angioplasty as a mode of therapy for recurrence of stenosis after initially successful angioplasty was examined on the basis of data on all 514 patients with successful angioplasty at Emory University before April 1982. Recurrence was found in 171 (33%) of the 514 patients. Repeat angioplasty was attempted in 95 patients with a significantly higher primary success rate (97 versus 85%, p less than 0.001) and a lower complication rate (8 versus 15%, p less than 0.10) than those of initial angioplasty. Follow-up documentation was available in all 92 patients with successful repeat angioplasty. A second recurrence of stenosis was found in 26% (24 of 92). A third angioplasty was performed in seven patients; six procedures were successful and there have been no recurrences of stenosis. Repeat coronary angioplasty provides a means to treat recurrence of stenosis. It proved to be very successful and safe and yielded good long-term results. It also increased the percent of patients with documented lasting success after angioplasty from 63 to 78%.

Restenosis and its determinants in first and repeat coronary angioplasty

“…A second PTCA, performed because of restenosis had a higher primary success rate than a first procedure (91 vs 67-5%, much like that in the other series (85% vs 61 % (231 ,97 vs 85%' 24) , 96% |26] . Major complications were fewer, also in agreement with published reports 123 " 241 .…”

“…However, a majority of this highly selected population (8/9 in our experience, 6/7 in the Atlanta report' 24 ' 13/23 in the series of the Mid America Heart Institute' 251 seems to have a favourable long term outcome. The only restenosis after PTCA 3 we experienced was on the proximal part of a venous bypass graft.…”

“…The Mid America Heart Institute reported a higher restenosis rate (37%) after repeat angioplasty* 251 . With an angiographic followup of 48% (23) and 61% (24) (not detailed in 1251 ), the restenosis rates (34% (23 >, 41 % 1241 , 37% ' 25] ) in these respective series might not be representative of the total PTCA 2 population. If, as suggested by the Atlanta study 1241 , the mean time interval between intervention and recurrence lengthens after repeat PTCA, a more complete angiographical follow-up might have revealed restenoses not yet clinically apparent.…”

The Coronary Angiogram and Its Seminal Contributions to Cardiovascular Medicine Over Five Decades

“…Early on, the angiogram also unmasked the principal limitation of this revolutionary technology, the problem of coronary restenosis at the site of the lesion originally dilated. 25 Finally, in this decade, the seeds were sewn for the thrombolytic era that was to follow by the rather audacious maneuver performed in Goettingen, Germany by Dr Peter Rentrop and colleagues. 26 He achieved and documented the successful reperfusion of the left anterior descending coronary artery of a middle aged man by first recanalizing the occluding thrombus with a guidewire and then infusing the proteolytic enzyme streptokinase directly into the artery.…”

Percutaneous transluminal coronary angioplasty for angina pectoris after a non-Q-wave acute myocardial infarction

“…Clinical and angiographic data are summarized in Table I. After the procedurei patients were monitored for 24 hours in the medium care unit. They were treated with nifedipine 60 mg daily and acetylsalicylic acid 500 mg daily over a period of 6 months.…”