Restenosis after coronary angioplasty: review of the literature

The average restenosis rate reported so far in the literature is just below 30%. Although restenosis correlates well with the recurrence of symptoms, the two factors are not identical. The incidence of myocardial infarction during the first 2 years after coronary angioplasty is 4% and the incidence of death is 2%. These two cardiac events are rarely the first symptom of restenosis. Restenosis, therefore, is not primarily a life threatening disease but still deserves prompt evaluation and correction. Restenosis is stenosis-related rather than patient-related. Thus, restenosis rate per patient increases with the number of lesions or arteries treated. Restenosis rates vary considerably with centres. Serial analyses of restenosis rates at individual centres revealed that the restenosis rates remained constant at a centre-specific level. Differences in case selection and particularities in data definition and analysis may account for both these observations. There is no sound evidence that procedural factors (balloon size, number, duration, or pressure of inflations, etc.) or drug regimens are capable of reducing the recurrence rate. All risk factors for restenosis identified so far are difficult to influence. Extinguishable factors such as smoking seem of little importance in this particular problem. Efforts to find ways of reducing restenoses after coronary angioplasty are commendable and necessary. Their chance of success, however, is small. 'Old customers' will continue to represent 20-30% of the clientele for coronary angioplasty. Their risk for failure and complications is small, but they do carry a considerable risk of restenosis.