Usefulness of percutaneous transluminal coronary angioplasty after new device coronary interventions

Percutaneous transluminal coronary angioplasty (PTCA) is often required immediately after laser and atherectomy devices to enlarge lumen dimensions and to salvage device failures. Between January 1989 and June 1992, adjunctive PTCA was applied to 83% of narrowings treated with new interventional devices, including 85% of transluminal extraction atherectomy (n = 290), 72% of high-speed mechanical rotational atherectomy (n = 79), and 89% of excimer laser angioplasty (n = 118) lesions (p = NS). Device success was defined as a decrease in diameter stenosis > or = 20%; procedural success was defined as a final diameter stenosis < or = 50% after PTCA; and salvage PTCA was defined as use of PTCA to manage device-induced vessel occlusion. Although adjunctive PTCA was applied to 487 lesions, it was used to further enlarge the lumen after initial device success in 139 lesions (28.5%). In contrast, adjunctive PTCA was used after initial device failure in 348 lesions (71.5%), including after minimal or no change (decrease in diameter stenosis by 0 to 19%) in diameter stenosis in 244 lesions (50%) and after worsening of diameter stenosis in 104 lesions (21.5%). Salvage PTCA after device-induced vessel occlusion was performed in 61 lesions (12.6%). However, final procedural success after PTCA was achieved in 412 lesions (85%), with a low incidence of Q-wave myocardial infarction (3.5%), emergency bypass surgery (1.8%) and death (2.3%).