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Repeat coronary angioplasty: efficacy of a third angioplasty for a second restenosis
P S Teirstein1, C A Hoover, R W Ligon
1Mid America Heart Institute, St. Luke's Hospital, Kansas City, Missouri.
Insights
Repeat percutaneous transluminal coronary angioplasty (PTCA) is effective for recurrent restenosis, but higher rates of re-blockage occur after third or fourth procedures. Long-term outcomes show a significant portion remain angina-free.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Recurrent restenosis after coronary angioplasty necessitates evaluating repeat interventions.
- The efficacy and outcomes of third and fourth percutaneous transluminal coronary angioplasty (PTCA) for second or third restenosis are not well-defined.
Observation:
- A study of 74 patients undergoing a third PTCA for a second restenosis showed a 93% procedural success rate.
- Late follow-up revealed a 43% rate of third restenosis, with factors including shorter intervals between procedures and left anterior descending artery involvement.
- Repeat PTCA, including fourth and fifth procedures, demonstrated high success rates but also higher restenosis rates compared to initial interventions.
Findings:
- Sixty-four percent of patients were angina-free at late follow-up after third, fourth, or fifth angioplasty.
- Procedural complications included emergency bypass surgery (27%) and in-hospital death (5%).
- Restenosis rates after third or fourth angioplasty for recurrent stenosis were higher than initial procedures.
Implications:
- Repeat PTCA can be effective for managing recurrent coronary artery restenosis, offering symptom relief for a majority of patients.
- Understanding factors associated with third restenosis can help refine patient selection and procedural planning.
- The increased risk of restenosis after multiple angioplasty procedures highlights the need for ongoing monitoring and consideration of alternative treatments.
Abstract:
To determine the efficacy of repeat percutaneous transluminal coronary angioplasty, 74 patients were studied who underwent a third angioplasty for a second restenosis of one coronary artery segment. The procedure was successful in 93% of patients. Procedural complications included emergency bypass surgery (three patients) and in-hospital death (two patients). At late follow-up (mean 18 months, range 7 to 49), 30 patients (43%) had a third restenosis treated with either a fourth angioplasty (16 patients), coronary bypass surgery (11 patients) or medical management (1 patient). Thirty-nine patients (57%) had no restenosis on the basis of follow-up angiography or absence of symptoms previously attributed to restenosis. Factors associated with a third restenosis included a shorter time interval (less than 3 months) between previous angioplasty procedures and dilation of the left anterior descending coronary artery. Among the 16 patients undergoing a fourth angioplasty for a third restenosis, the procedural success rate was 94%. One patient required emergency bypass surgery. At late follow-up (mean 16 months, range 7 to 38), eight patients (53%) had a fourth restenosis treated with either a fifth angioplasty (one patient), bypass surgery (five patients) or medical management (two patients). Considering all 74 patients undergoing a third angioplasty for a second restenosis, 27% had bypass surgery, 5% died, 4% were managed medically and 64% were free of angina at late follow-up after either a third, fourth or fifth angioplasty. Restenosis rates after a third or fourth angioplasty procedure for recurrent restenosis are higher than those for the initial procedures.(ABSTRACT TRUNCATED AT 250 WORDS)