DELAYED ANGIOPLASTY OF THE RESIDUAL STENOSIS FOLLOWING THROMBOLYSED INFARCTION - OUTCOME AFTER 6 MONTHS OF ARTERIAL PERMEABILITY AND LEFT-VENTRICULAR FUNCTION

At medium term, the results of delayed angioplasty (DA) following intr avenous thrombolysis (IVT) in terms of arterial permeability but parti cularly of left ventricular function (LVF) is still poorly understood and is the subject of this prospective study. Over 18 months, 76 patie nts underwent DA for the residual stenosis on day 8 +/- 5 with complet e and partial success rates of 88.2 % and 11.8 % respectively. Rapid r eocclusion (< 48 hours) was documented in 9.2 % of cases. After 6 mont hs, there had been no deaths and no recurrence of infarction but a rec urrence of angina in 23.7 % of cases. Angiographic monitoring, carried out in 56 cases (73.7 %) after 6 +/- 2.4 months identified 21 resteno ses (37.5 %) and 6 reocclusions (10.7 %). 12 of the restenoses were su ccessfully redilated. The effect on LV function was investigated in 50 patients. In the absence of reocclusion, the ejection fraction and th e kinetics of the infarcted territory were improved ; significant rest enoses (> 60 % by digital densitometry) did not appear to offset these improvements. In addition to the maintenance of arterial permeability , the possibility of functional recovery appears to be conditioned by the degree of contractile abnormality observed during the initial vent riculography. Despite the absence of restenoses after 6 months, the oc currence on day 6 of akinesia or above all of dyskinesia reduces the c hances of contractile improvement with as a corollary more marked LV c hanges.