Restenosis after multilesion percutaneous transluminal coronary angioplasty

Abstract

Experience and new technical advances have resulted in an increasing number of patients with multivessel coronary disease who can be considered for percutaneous transluminal coronary angioplasty (PTCA). In selected patients with multivessel coronary disease, PTCA is a safe and effective procedure for the immediate relief of anginal symptoms. However, many questions remain regarding the long-term therapeutic benefit of the procedure. Few data are available on the incidence and clinical significance of restenosis after multilesion PTCA. Clearly, there is the potential for a higher rate of restenosis in patients who undergo dilatation of more than 1 lesion. Determination of restenosis rates after multilesion PTCA is important in the definition of expanded indications for this procedure. Because of the variations in definitions of restenosis and in patient selection factors, reported recurrence rates after multilesion PTCA are not easily compared between patient series. After multilesion dilatation the risk of developing at least 1 recurrent lesion ranges from 26% to 53% and appears to be greater than that reported for single lesion PTCA. Multilesion restenosis occurs in 7% to 21% of patients who undergo multilesion PTCA and is frequently observed in patients with recurrent symptoms. “Silent” multilesion restenosis (i.e., multiple lesion restenosis without symptoms) is rare. A higher risk of restenosis at one of several dilatation sites in a patient with extensive coronary disease should not be a deterrent in recommending multilesion PTCA to selected patients with multivessel coronary disease because the procedure provides important symptomatic relief to most. Further, recurrent narrowings are usually amenable to a second dilatation attempt if clinically indicated.