Restenosis after PTCA

Luminal renarrowing after percutaneous transluminal coronary angioplasty (PTCA), or 'restenosis,' is a complex, multifactorial phenomenon that cannot readily be predicted from baseline characteristics. However, the extent of angiographic luminal gain achieved at PTCA appears to be the strongest predictor of the degree of angiographic renarrowing. Despite this knowledge, an 'aggressive' interventional approach has been advocated, based on the finding that a larger postprocedural lumen provides a greater residual lumen at follow-up. Various new revascularization devices are finding respective treatment niches, but none of these devices has convincingly shown a reduction in luminal renarrowing, when compared with 'good old, plain old' balloon angioplasty. Different groups disagree over the most appropriate index for comparing the long-term angiographic impact of different devices. Use of increasingly sophisticated analytical approaches for evaluating immediate- and long-term angiographic outcome may help resolve this disagreement and may facilitate meaningful comparisons between different interventions and different clinical trials.