TREATMENT OF RESTENOSIS - A UNIFIED OR LESION SPECIFIC
APPROACH? A.E. Ajani*, R. Shetty, R. Warren, D. Eccleston and J. Lefkovits. Royal Melbourne Hospital, Melbourne. Aim: Clinically apparent restenosis (CR) has become the
major limitation of coronary intervention.
We aimed to determine treatment outcomes for stenosis according to the
initial therapy and subsequent treatment modality. Methods & Results: A
retrospective analysis was conducted on 1362 consecutive patients undergoing
percutaneous intervention between 9/97 to 3/99. CR rates were 8.8% of 442 patients initially treated with balloon
PTCA and 5.4% of 920 patients initially treated with stents. The median time to treatment of CR was 5.82
months (range 0.9-77.1mths). At least
6-month follow-up was available in all patients. Three discrete groups of CR patients were identified as shown in
the Figure. No major demographic differences were evident between the
3 groups. Low rates of death and
myocardial infarction (MI) were found in all groups. There was no significant
difference in the incidence of the composite endpoint in patients with in-stent
restenosis treated with balloon 23.1% (6/26), stenting 20% (4/20) or
rotablation ± stent 25% (1/4).
Conclusions: Low rates of
clinically significant restenosis were seen in contemporary Australian-style
angioplasty practice. There were clearly defined outcome patterns in the
treatment of restenosis with a strong indication for stenting restenosis after
balloon PTCA. Treatment of in-stent
restenosis results in low rates of clinically significant restenosis regardless
of treatment modality. 
