[Repeated recurrences after balloon dilatation--dilate or operate?].

In a total of 333 patients who had undergone a first successful transluminal coronary angioplasty (TCA) of a single stenosis in a native coronary vessel, restenosis occurred in 15% (follow-up angiography was performed in 94% of these patients). The restenosis rate was higher in bypass stenoses (45%) and in reopened vessels (54%). Repeat dilatation of restenoses showed a high primary success rate (93%) and only a few complications (2%). In this group, recurrent restenosis was observed in 33% of patients. Thirteen patients with recurrent restenoses (11 patients with two recidivations and two patients with three) underwent a total of 41 dilatation attempts. The degree of the recurrent stenosis (prior to the first TCA: 89%; prior to the second: 82%; prior to the third: 74%), the number of eccentric stenoses (8; 7; 5, respectively) and the length of the stenotic obstruction (5.2 mm; 4.7 mm; 4.3 mm, respectively) decreased. Accordingly, exercise tolerance was improved (99 W, 133 W, 146 W). To date, follow-up angiography and functional investigations have been performed in 11 out of 13 patients. Good long-term results have been observed in eight patients and another restenosis in three. It is concluded that repeat angioplasty is a reasonable therapeutic approach also in patients with recurrent restenosis.