[Redilatation of coronary stenoses. Effect on long-term results]

Subsequent to percutaneous transluminal coronary angioplasty (PTCA), with a primary success rate of between 84 and 94%, restenosis is reported to occur in 17 to 47%. Redilatation has been considered in about 30% of dilated patients and carried out in 20%. The experience presented is based on 608 consecutive patients who underwent PTCA at Emory University in Atlanta as well as 350 consecutive patients treated at the University of Genf. In general, the primary success rate of repeated PTCA is reported to be significantly better. Based on our data, the primary success of redilatation was 97%, as compared with an 87% success rate on initial dilatation. Associated with second and third dilatations, there is a substantially lower incidence of complications; in our patients, obstructive dissections occurred in 1% as compared with 7% at the time of initial dilatation and myocardial infarction was not observed (as compared with 1% initially). Emergency bypass surgery was required in only 1% as compared with 5% at initial dilatation. With regard to longterm results, the data reported shows some differences. While most of the figures indicate a rate of restenosis comparable to that seen after initial dilatation, a higher incidence of restenosis has been observed. In our patients, the rate of restenosis after repeat PTCA was essentially similar to that seen after initial PTCA; overall, however, that associated with LAD stenoses was notably higher. On use of redilatation, 78% of all patients, instead of only 63% after successful initial dilatation, had longterm benefits from this mode of therapy.