Total Coronary Artery Occlusion Late after Successful Coronary Angioplasty of Moderately Severe Lesions: Incidence and Clinical Manifestations

Abstract

Coronary restenosis after balloon angioplasty is a slow process that develops over a few months. In some patients, with an initially successful angioplasty, an artery that originally had only moderate stenosis becomes totally occluded as a result of restenosis. This report describes 16 such patients out of 415 dilated lesions with late angiographic follow-up. Ten patients presented with stable angina pectoris, 5 had unstable angina and only one was admitted with a small myocardial infarction. Visible collaterals were present in 15 patients. Except for the patient who sustained myocardial infarction, none of the late angiograms showed the typical morphological features of acute lesion. We conclude that total coronary occlusion late after successful angioplasty of an artery that was moderately narrowed is rare. The ‘restenotic’ occlusion is a slow process that stimulates collateral formation and thus the risk of myocardial infarction is small.

Late Coronary Occlusion After Intracoronary Brachytherapy

“…12 In contrast, our study shows a high incidence (6.6%) of thrombotic clinical events 2 to 15 months after PTCA and brachytherapy.…”

Endovascular Brachytherapy and Late Thrombotic Occlusion

“…The incidence of myocardial infarction caused by late (Ͼ30 days) coronary occlusion, as documented by angiography, is extremely rare after percutaneous intervention in the general, nonirradiated population. 3 The finding that only 2 of the 854 patients (0.2%) enrolled in the Belgian Netherlands Stent Study (BENESTENT), BENESTENT II pilot phase, and BE-NESTENT II trials had myocardial infarction associated with late target vessel occlusion further supports this concept.…”

Histopathologic Evaluation of Coronary Artery Thrombi Obtained by Directional Coronary Atherectomy in Patients With Restenosis-Induced Unstable Angina Pectoris

“…Rozenman et al studied 16 of 415 patients who were undergoing PTCA and who developed total occlusion because of restenosis and found that only one case sustained a small myocardial infarct, with the remaining 15 cases developing only angina pectoris because of the presence of collateral circulation. 23 These reports indicate significant differences in the clinical course between patients who develop UAP because of the formation of new arteriosclerotic lesions and those who develop it because of restenotic lesions after PTCA or DCA.…”