The problem of reocclusion and restenosis — Clinical aspects

Abstract

Summary Balloon angioplasty is practised world-wide today and has become the treatment of choice for many patients with coronary heart disease. However, its acute success rate is impaired by the phenomenon of reocclusion and its chronic success rate is reduced by the phenomenon of restenosis. Acute coronary occlusion occurs in 4.3 to 8.3% and is associated with a high mortality and myocardial infarction rate. Continuous monitoring of changes in the sum of three dimensional ST- and QRS- vectors is a valuable tool in the detection of reocclusion, which may occur silently. Attempts to manage this situation adequately include resolution of coronary spasm and prolonged dilatation with perfusion balloons. Application of intracoronary stents appear to be not only an effective alternative, but also superior in short and long term. Restenosis, affecting 30–40% of successfully dilated coronary arteries, remains the second major clinical problem; the underlying pathophysiological mechanisms of which are still poorly understood. Many pharmacological and technical attempts to decrease the incidence and extent of restenosis have been made, but in clinical trials none has been proven to be successfully so far.