Pattern of Restenosis after Percutaneous Transluminal Coronary Angioplasty of Bifurcation Stenoses

Abstract

Bifurcation stenoses have been recognized to be at a “high risk” for acute closure during percutaneous transluminal coronary angioplasty. Development of advanced techniques using simultaneous (“kissing”) balloon inflation or sequential balloon inflations, using two guidewires to preserve access to both branches while avoiding the trauma produced by inflating two balloons in a small artery simultaneously, has allowed safe and effective dilatation of bifurcation stenoses. Little is known, however, about the restenosis rate and pattern of bifurcation stenoses. This article reports on 44 patients who were treated successfully using the sequential inflation technique on their bifurcation stenoses. A total of 88 lesions were dilated. Restenosis occurred in 25 of the 88 lesions (28%) within 8.5 ± 2.25 months. Eleven patients had restenosis in one vessel while seven patients had restenosis in both branches (18 of 44–41%). All 18 underwent a second PTCA attempt and 15 patients had successful repeat PTCA. Thus, the primary restenosis rate in bifurcation stenosis is acceptably low, occurring in both branches in a minority of cases (7/18). The total restenosis rate is no greater than expected with single vessel PTCA. Repeat PTCA is usually easily accomplished with good secondary success, aided by the fact that the majority of the restenoses involve only one rather than both branches of the bifurcation stenosis. (J Interven Cardiol 1989:2:3)