Restenosis after successful percutaneous transluminal coronary angioplasty

Abstract

R ESTENOSIS after initially successful percutaneous transluminal coronary angioplasty (PTCA) remains one of the most important unresolved problems associated with this procedure, occurring in approximately 25% to 35% of patients. The peculiar pattern of restenosis is such that the recurrence of signs and symptoms of ischemia appears in the vast majority of patients between 2 and 5 months after the procedure, and is rarely seen after 8 months.‘-4 Although restenosis usually can be effectively managed by repeat PTCA,596 the large number of patients so affected adds significantly to the morbidity and detracts from the potential economic advantages of this therapeutic modality. It might even be argued that PTCA is medically ineffective and financially wasteful in the occasional patient who requires multiple repeat PTCAs’ and ultimately, coronary bypass surgery. Ever mindful that restenosis is a common problem with obvious clinical implications, physicians routinely monitor post-PTCA patients with frequent stress tests, adding to its financial and emotional cost. Restenosis rates have remained constant despite improved initial results in ever more complex cases; hence, better catheter and guidewire technoIogy and increased operator experience are not the answers to this problem.3*8*g Recognition that recent clinical trials of antiplatelet agents and vasodilators have proven ineffective as preventive measures is a further sobering thought. Where do we go from here? This review of potential mechanisms of restenosis and the factors influencing its occurrence is undertaken on the premise that a compilation of such information will benefit both the clinician and the investigator.