RESTENOSIS PRESENTING AS TOTAL OCCLUSION AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY - CLINICAL-PARAMETERS AND EFFICACY OF REPEAT ANGIOPLASTY

To assess parameters predicting restenosis presenting as new total occlusion after percutaneous transluminal coronary angioplasty, and the efficacy of repeat angioplasty when performed, the data on patients with this angiographic feature were collected from two institutions. Patient characteristics and angiographic features at initial angioplasty were compared to a control sample of patients with angiographic restenosis without total occlusion. Subgroup analysis of the study population undergoing repeat angioplasty was then performed. 113 of 5,650 patients (2%) undergoing angiographic restudy during the time period January 1987 - December 1990 were found with new total occlusion restenosis. At initial angioplasty these patients were more likely to have had previous coronary bypass surgery and a history of myocardial infarction (both p=0.01). They had an increased incidence of multivessel coronary disease (p=0.02), and decreased left ventricular function (p=0.05). Of procedural variables at initial angioplasty, the specific vessel dilated predicted restenotic total occlusion: bypass graft conduits and right coronary arteries were at increased risk (p<0.001 for both vessels). Sixty-four patients underwent repeat angioplasty of the new occlusion restenosis, with a primary success rate of 79.7%. When compared to a control sample success rate of 97.6%, this differed at p<0.001. The findings indicate that restenosis presenting as a new total occlusion occurs more commonly in defined clinical and angiographic settings. More importantly, repeat angioplasty for these patients is often unsuccessful (clinical success=79%). Early identification of these patients may help minimize adverse events at followup.