TANDEM LESION CORONARY ANGIOPLASTY - 10 YEARS EXPERIENCE

Background: To evaluate the acute and long-term results of 'tandem les ion' coronary angioplasty in the left anterior descending artery, and to identify the determinants of restenosis. Methods: A retrospective a nalysis of clinical, angiographic, and procedure-related variables was carried out on a consecutive series of 102 patients (mean age 54 year s, range 34-71 years; 77% men) who had undergone tandem lesion coronar y angioplasty in the left anterior descending artery (204 lesions) bet ween 1981 and 1991. Results: Angiographic success was achieved in 96 p atients (94%) and 195 lesions (96%). Clinical success was achieved in 91 patients (89%). Five patients (5%) suffered a non-fatal Q-wave myoc ardial infarction. No procedural deaths occurred. Complete follow-up d ata were available for all 102 patients (median 46 months, range 1-122 months). During the follow-up period, two patients (2%) died, two (2% ) suffered non-fatal myocardial infarction, and 18 (18%) underwent a s econd revascularization procedure. The cumulative probability of survi val was 98.9% and 97.8% at 1 and 5 years respectively. Survival free f rom myocardial infarction, bypass surgery and repeat angioplasty at 1 and 5 years was 80.8% and 74.9% respectively. Thirty patients underwen t repeat angiography (mean 8.8 months) for symptoms or evidence of rev ersible ischaemia. Restenosis occurred at a single dilated site in 14 patients and at both sites concurrently in six patients. Eight patient s had no restenosis but two had total occlusion of the left anterior d escending artery. Multiple logistic regression analysis identified inc reased inflation frequency as the only independent predictor of resten osis. Conclusions: Tandem lesion coronary angioplasty of the left ante rior descending artery can be performed with a high primary success ra te and favourable long-term outcome. The fact that restenosis occurred at a single site more often than at both, suggests that systemic fact ors are less important than local factors in influencing restenosis.