Angiographic patterns of restenosis after angioplasty of multiple coronary arteries

To assess angiographic patterns of restenosis after percutaneous transluminal coronary angioplasty (PTCA) of multiple coronary arteries, angiograms were reviewed in 40 patients with clinical recurrence after PTCA of multiple arteries. Clinical recurrence was defined as return of symptoms after successful PTCA of more than 1 major artery or branch and angiographic evidence of restenosis of 1 or more lesions. In these 40 patients, 83 arteries (2.1 arteries per patient) and 103 narrowings (2.6 narrowings per patient) were successfully dilated. Restenosis developed in 57 of 83 arteries at risk (69%): 23 patients (58%) had restenosis in only 1 artery and 17 (42%) in 2 arteries. Restenosis occurred in 63 of 103 lesions at risk (61%): 20 patients (50%) had restenosis of 1 narrowing, 17 (43%) had restenosis of 2 narrowings and 3 (7%) had recurrence of 3 narrowings. Only 13 patients (33%) had restenosis of all narrowings dilated. Predictors of restenosis of individual narrowings were: higher pre-PTCA percent stenosis (87 +/- 10% in narrowings with restenosis vs 82 +/- 10% in narrowings without, p less than 0.02), and higher degree of residual stenosis after PTCA (46 +/- 13% in narrowings with restenosis vs 36 +/- 12% in narrowings without, p less than 0.001). Balloon size or inflation pressure did not predict recurrence of narrowings. Repeat PTCA was successful in 97% of cases attempted (33 of 34), 3 patients underwent elective bypass surgery and 3 were managed with medical therapy. Most patients with clinical recurrence after PTCA of multiple arteries do not have restenosis of multiple arteries or narrowings, and only one-third will have recurrence of all narrowings.(ABSTRACT TRUNCATED AT 250 WORDS)