title: Repeat coronary angioplasty: efficacy of a third angioplasty for a second restenosis.
abstract: To determine the efficacy of repeat percutaneous transluminal coronary angioplasty, 74 patients were studied who underwent a third angioplasty for a second restenosis of one coronary artery segment. The procedure was successful in 93% of patients. Procedural complications included emergency bypass surgery (three patients) and in-hospital death (two patients). At late follow-up (mean 18 months, range 7 to 49), 30 patients (43%) had a third restenosis treated with either a fourth angioplasty (16 patients), coronary bypass surgery (11 patients) or medical management (1 patient). Thirty-nine patients (57%) had no restenosis on the basis of follow-up angiography or absence of symptoms previously attributed to restenosis. Factors associated with a third restenosis included a shorter time interval (less than 3 months) between previous angioplasty procedures and dilation of the left anterior descending coronary artery. Among the 16 patients undergoing a fourth angioplasty for a third restenosis, the procedural success rate was 94%. One patient required emergency bypass surgery. At late follow-up (mean 16 months, range 7 to 38), eight patients (53%) had a fourth restenosis treated with either a fifth angioplasty (one patient), bypass surgery (five patients) or medical management (two patients). Considering all 74 patients undergoing a third angioplasty for a second restenosis, 27% had bypass surgery, 5% died, 4% were managed medically and 64% were free of angina at late follow-up after either a third, fourth or fifth angioplasty. Restenosis rates after a third or fourth angioplasty procedure for recurrent restenosis are higher than those for the initial procedures.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Mid America Heart Institute, St. Luke's Hospital, Kansas City, Missouri.
authors.forename: P S
authors.initials: PS
authors.lastname: Teirstein
authors.forename: C A
authors.initials: CA
authors.lastname: Hoover
authors.forename: R W
authors.initials: RW
authors.lastname: Ligon
authors.forename: L V
authors.initials: LV
authors.lastname: Giorgi
authors.forename: B D
authors.initials: BD
authors.lastname: Rutherford
authors.forename: D R
authors.initials: DR
authors.lastname: McConahay
authors.forename: W L
authors.initials: WL
authors.lastname: Johnson
authors.forename: G O
authors.initials: GO
authors.lastname: Hartzler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D003327:Coronary Disease / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence