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Percutaneous transluminal coronary angioplasty more than twice for the same coronary lesion.

To determine outcome and predictors of restenosis after three or more PTCAs for the same coronary lesion we studied 23 patients (17 patients three PTCAs; five patients four PTCAs; one patient six PTCAs). The primary success rate was 100%. Myocardial infarction was seen in one patient; there was no emergency surgery or mortality. Duration of follow-up after the last PTCA was 11-58 months (mean 26 months). Restenosis occurred in 6 of 23 patients (26.1%) after the last PTCA. The symptom-free interval before the last PTCA was less than or equal to 3 months in five of these six patients, a larger balloon for the last PTCA was used in two patients. After the last PTCA 17 of the 23 patients (73.9%) were asymptomatic; repeat angiography in seven of them revealed no restenosis. The symptom-free interval before the last PTCA was less than 3 months in eight patients, and a larger balloon was used in six of these. In nine patients the interval was greater than 3 months, and a larger balloon was used in two. When the symptom-free interval before the last PTCA was less than or equal to 3 months, restenosis occurred in two of eight patients (25%) in whom a larger balloon was used, but in three of five patients (60%) in whom a larger balloon was not used. When the interval before the last PTCA was less than or equal to 3 months five of 13 patients (38.5%) developed restenosis, but when it was greater than 3 months only one of 10 patients did so.