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Restenosis After Percutaneous Transluminal Coronary Angioplasty
Coronary angiography was performed in a 54-year-old man with low-level stable angina. He had undergone percutaneous transluminal coronary angioplasty (PTCA) 3 months earlier. The angiogram showed tight stenosis of the proximal left anterior descending artery. The lesion was successfully dilated during a second PTCA, and a stent was placed using a flexible catheter.
Coronary angiography was performed in a 54-year-old man with low-level stable angina. He had undergone percutaneous transluminal coronary angioplasty (PTCA) 3 months earlier. The angiogram showed tight stenosis of the proximal left anterior descending artery (A, arrows). The lesion was successfully dilated during a second PTCA, and a stent was placed using a flexible catheter (B).
Drs Ahmad Hakemi and Daniel Radawski of Central Michigan University in Mt Pleasant write that restenosis develops within 6 months after PTCA in 30% to 40% of patients and in 20% to 30% of those who have PTCA with follow-up stenting.1,2 Restenosis occurs more frequently in patients who have had balloon angioplasty of proximal lesions of the left anterior descending artery. In this setting, balloon angioplasty with stent placement generally produces a better outcome than conventional angioplasty. Elective placement of stents reduces the restenosis rate and increases the effectiveness of conventional balloon angioplasty.3,4
Because of smooth muscle cell proliferation, restenosis also may occur in patients who have had a stent placed. Intracoronary irradiation and chemotherapeutic stent coatings to reduce the incidence of in-stent restenosis are being investigated. After the procedure, this patient was given potent antiplatelet therapy; he resumed his normal activities. He had no pain 1 year later
REFERENCES:1. Fischman DL, Leon MB, Baim DS, et al. A randomized comparison of coronary stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med. 1994;331:496-501.
2. Serruys PW, de Jaegere P, Kiemeneij F, et al. A comparison of balloon ex-pandable-stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med. 1994;331:489-495.
3. Al Suwaidi J, Berger PB, Holmes DR Jr. Coronary artery stents. JAMA. 2000;284:1828-1836.
4. Holmes DR Jr, Bell MR. Left anterior descending artery stenosis: the widow maker revisited. Mayo Clin Proc. 2000;75:1113-1115.
