Recurrent restenosis after transluminal coronary angioplasty--dilatation or surgery?

In a total of 333 patients who had undergone a first successful transluminal coronary angioplasty (TCA), restenosis occurred in 17% (follow-up angiography was performed in 94% of patients). The restenosis rate was higher in bypass stenoses (45%) and re-opened vessels (54%). Repeat dilatation of restenoses had a high acute success rate (93%) and only few severe complications (2%). In this group the restenosis rate was 33%. Thirteen patients with recurrent restenoses (11 patients with two, and two patients with three recidivations) underwent a total of 41 dilatation attempts. The degree of stenoses (prior to the first TCA, 89%; prior to second TCA, 82%; prior to third TCA, 74%), the number of eccentric stenoses (8, 7, 5, respectively) and the length of the stenotic obstruction (5.2 mm, 4.7 mm, 4.3 mm, respectively) decreased. Accordingly, exercise tolerance improved (99 W, 133 W, 146 W, respectively). To date, follow-up angiography and functional investigations have been performed for 10 out of 13 patients. Good long-term results were observed in seven patients. Further restenoses occurred in three patients. It is concluded that repeat angioplasty is a reasonable therapeutic approach even for patients with recurrent restenoses.