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Published on: September 14, 2009
Preangioplasty complicated coronary stenosis morphology as a predictor of restenosis
D Tousoulis1, J C Kaski, G Davies
1Cardiovascular Research Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, England.
Insights
Complicated coronary stenosis morphology before percutaneous transluminal coronary angioplasty (PTCA) significantly increases restenosis risk. Unstable angina also correlates with higher restenosis rates after PTCA.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Restenosis after percutaneous transluminal coronary angioplasty (PTCA) remains a clinical challenge.
- Coronary stenosis morphology is a potential predictor of restenosis, but requires further investigation.
Purpose of the Study:
- To determine if complicated pre-PTCA coronary stenosis morphology is associated with restenosis.
- To evaluate the relationship between initial angina presentation and restenosis rates.
Main Methods:
- Retrospective analysis of 41 patients (47 stenoses) undergoing repeat angiography 6-8 months post-PTCA.
- Computerized quantitative coronary angiography used to assess stenosis morphology and diameter before, immediately after, and at follow-up PTCA.
- Classification of stenoses into concentric, eccentric, and complicated categories based on pre-PTCA morphology.
Main Results:
- Complicated stenoses showed a significantly higher restenosis rate (70%) compared to eccentric (33%) and concentric (11%) stenoses (p<0.05).
- No significant difference in stenosis diameter before or immediately after PTCA was observed between patients with and without restenosis.
- Restenosis occurred more frequently in patients presenting with unstable angina (61%) versus stable angina (30%).
- Complicated lesions in unstable angina patients had the highest restenosis rate (8/12).
Conclusions:
- Pre-PTCA complicated coronary stenosis morphology is a strong predictor of restenosis.
- Angina presentation (stable vs. unstable) is also a significant factor influencing restenosis risk after PTCA.
- Morphological changes post-PTCA did not significantly differ between restenosed and non-restenosed lesions, emphasizing pre-procedural morphology's importance.
Abstract:
To assess whether complicated preangioplasty coronary stenosis morphology is associated with restenosis, 41 patients (47 stenoses) who underwent repeat angiography 6 to 8 months after percutaneous transluminal coronary angioplasty (PTCA) were studied. Stenosis diameter and morphology were assessed by computerized quantitative coronary angiography before and immediately after PTCA and at follow-up angiography. Before PTCA 18 stenoses were concentric (symmetric narrowings with smooth borders), 12 were eccentric (asymmetric narrowings with smooth borders), and 17 were complicated (asymmetric with rough borders and overhanging edges). Restenosis occurred in 18 lesions: two (11%) concentric, four (33%) eccentric, and 12 (70%) complicated (p less than 0.05), whereas 29 lesions remained unchanged. Stenosis diameter before and immediately after PTCA was not significantly different in the 18 patients with and the 23 patients without restenosis. Follow-up angiograms showed that 11 (61%) stenoses in the group with restenosis and 18 (63%) in the group without restenosis had morphology similar to that before PTCA. Restenosis occurred in seven (30%) patients who initially had chronic stable angina and in 11 (61%) who were first seen with unstable angina (p less than 0.05). In patients with stable angina 1 of 13 concentric stenoses, two of eight eccentric stenoses, and four of five complicated lesions restenosed. In patients with unstable angina one of five concentric, two of four eccentric, and 8 of 12 complicated lesions had restenosis. Stenoses that were complicated before PTCA tended to adopt an irregular morphology if they recurred, whereas concentric stenoses rarely occurred.(ABSTRACT TRUNCATED AT 250 WORDS)
