Frequency of restenosis after balloon pulmonary arterioplasty and its causes

Restenosis has been described after balloon pulmonary arterioplasty (BPA), but little is known about its frequency, settings, and time course. We unde rtook this study to (1) determine the incidence of restenosis after BPA, an d (2) identify its potential determinants. We reviewed clinical data and me asured pulmonary artery diameters from angiograms of 134 dilations on 75 pa tients (median 2.1 years, range 0.3 to 32) who had BPA from January 1990 to June 1998. Successful BPA was defined as a greater than or equal to 50% in crease in predilation diameter, whereas restenosis was said to occur if the re was a greater than or equal to 50% loss in initial diameter gain, The su ccess rate after BPA by angiographic criteria was 64% (95% confidence inter val 56% to 73%), Seventy-four percent of BPAs were successful by published standard criteria (angiographic criteria or greater than or equal to 20% ch ange in right ventricular/aortic pressure), Baseline demographic variables and predilation parameters were not predictive of initial dilation success. Restenosis occurred in 35% (95% confidence interval 22% to 49%) of success fully dilated vessels. Only weight at follow-up (p = 0.02) was associated w ith an increased likelihood of restenosis. Predilation parameters, technica l aspects of dilation, or immediate results of BPA were not predictive of r estenosis, We therefore conclude that restenosis is unpredictable and more common after BPA than previously recognized. (C) 2000 by Excerpta Medica, I nc.