THE PROBLEM OF REOCCLUSION AND RESTENOSIS - CLINICAL ASPECTS

Balloon angioplasty is practised world-wide today and has become the t reatment of choice for many patients with coronary heart disease, Howe ver, its acute success rate is impaired by the phenomenon of reocclusi on and its chronic success rate is reduced by the phenomenon of resten osis, Acute coronary occlusion occurs in 4.3 to 8.3% and is associated with a high mortality and myocardial infarction rate. Continuous moni toring of changes in the sum of three dimensional ST- and QRS- vectors is a valuable tool in the detection of reocclusion, which may occur s ilently, Attempts to manage this situation adequately include resoluti on of coronary spasm and prolonged dilatation with perfusion balloons, Application of intracoronary stents appear to be not only an effectiv e alternative, but also superior in short and long term. Restenosis, a ffecting 30-40% of successfully dilated coronary arteries, remains the second major clinical problem; the underlying pathophysiological mech anisms of which are still poorly understood, Many pharmacological and technical attempts to decrease the incidence and extent of restenosis have been made, but in clinical trials none has been proven to be succ essfully so far.