USEFULNESS OF PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY AFTER NEW DEVICE CORONARY INTERVENTIONS

Percutaneous transluminal coronary angioplasty (PTCA) is often require d immediately after laser and atherectomy devices to enlarge lumen dim ensions and to salvage device failures. Between January 1989 and June 1992, adjunctive PTCA was applied to 83% of narrowings treated with ne w interventional devices, including 85% of transluminal extraction ath erectomy (n = 290), 72% of high-speed mechanical rotational atherectom y (n = 79), and 89% of excimer laser angioplasty (n = 118) lesions (p = NS). Device success was defined as a decrease in diameter stenosis g reater than or equal to 20%; procedural success was defined as a final diameter stenosis less than or equal to 50% after PTCA; and salvage P TCA was defined as use of PTCA to manage device-induced vessel occlusi on. Although adjunctive PTCA was applied to 487 lesions, it was used t o further enlarge the lumen after initial device success in 139 lesion s (28.5%). In contrast, adjunctive PTCA was used after initial device failure in 348 lesions (71.5%), including after minimal or no change ( decrease in diameter stenosis by 0 to 19%) in diameter stenosis in 244 lesions (50%) and after worsening of diameter stenosis in 104 lesions (21.5%). Salvage PTCA after device-induced vessel occlusion was perfo rmed in 61 lesions (12.6%). However, final procedural success after PT CA was achieved in 412 lesions (85%), with a low incidence of Q-wave m yocardial infarction (3.5%), emergency bypass surgery (1.8%) and death (2.3%).