Coronary angioplasty: clinical and angiographic follow-up

To evaluate the clinical status and restenosis rate after percutaneous transluminal coronary angiography (PTCA), 251 consecutive patients who had undergone a successful procedure from February 1979 to May 1983 were studied. Angiography was done routinely in 92 of the initial 100 consecutive patients in whom the procedure was successful (group I), 1 to 11 months (mean 6) after PTCA. Restenosis occurred in 37 of 92 patients (40%); all but 2 (who had collateral flow to the restenosed vessel) had symptoms. Conversely, 44 of 46 asymptomatic patients had no restenosis. The other 159 patients (group II) were followed up clinically, with angiography performed only if signs or symptoms of ischemia recurred. Restenosis suspected clinically and confirmed angiographically occurred in 35 of 92 patients (38%) in group I and 36 of 154 patients (23%) in group II. Of 251 patients with follow-up of at least 6 months, 109 patients (43%) became symptomatic. Of 109 symptomatic patients, 104 consented to coronary angiography; restenosis was found in 67%, progression of narrowing in other arteries occurred in 13%, and the remaining patients were presumed to have large or small vessel vasospasm. The mortality rate for the entire group was 0.8%. When repeat angioplasty was applied to patients with restenosis, over 80% of the group improved at an average follow-up time of 21 months. Symptomatic restenosis may occur less often when higher balloon inflation pressures are used during PTCA.