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The coronary arteries are the major blood vessels supplying the heart, and under abnormal conditions, they may become narrowed, causing a condition known as stenosis. Stenosis can be treated by percutaneous transluminal coronary angioplasty (PTCA), a method in which a balloon attached to a catheter, a tube-like structure, is inserted into the coronary artery, and inflation of the balloon causes dilation or widening of the narrowed vessel. However, stenosis may sometimes recur following PTCA. The site and structure of restenosis were examined by angiography, X-ray imaging of blood vessels, and compared with the sites of stenosis before and immediately after PTCA in 47 patients with 55 restenoses. Restenosis sites or lesions were physically similar to stenosis sites before angioplasty in 29 cases and after angioplasty in 25 cases. When the lesions with greater than 25 percent narrowing were excluded from analysis, restenosis lesions were similar to stenosis lesions before angioplasty in 15 of 30 cases and after angioplasty in 25 of 30 cases. Restenosis usually occurred at the same site as the original stenosis. The appearance of the lesion after angioplasty was a better predictor of recurrence of stenosis than its appearance before angioplasty, but only if restenosis occurred within 5 millimeters from the original site of stenosis. The results show that restenosis is usually different in physical nature from the stenosis lesion before angioplasty, and repair processes after angioplasty are important in preventing recurrence of stenosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Coronary artery disease (CAD) is characterized by reduced flow of blood to the heart muscle through narrowed coronary arteries; since the blood supply is diminished, the heart does not receive sufficient oxygen. Angina, or chest pain, may occur and if an artery becomes completely blocked, myocardial infarction (heart attack) results. One method of treating CAD is by coronary angioplasty, which involves inserting a collapsed balloon into the narrowed (stenosed) artery; the goal of the procedure is to dilate the stenosis when the balloon is expanded. Angioplasty does not require open heart surgery. The value of using angioplasty to treat young patients with CAD was assessed at one hospital over an eight-year period. Of 8,000 angioplasty procedures, 89 were performed in 71 patients under age 35. The heart is served by four coronary arteries, and 58 percent of the young patients had disease in more than one coronary vessel. In this group, a total of 253 diseased arteries were treated with angioplasty and 242 vessels (95.6 percent) were successfully dilated. Only one complication occurred in which the patient required immediate coronary artery bypass grafting surgery (a healthy vessel is grafted from the main artery, the aorta, to a site on the coronary artery beyond the stenosis). At follow-up, an average of 32 months after angioplasty, 50 patients (72 percent) had no symptoms of CAD, one patient had died, four had suffered nonfatal heart attacks and seven had undergone bypass surgery. Seventeen patients (25 percent) required repeat angioplasty. In young patients with CAD, angioplasty is safe and highly successful with an excellent three-year survival rate; it appears to be safer than bypass surgery for the young patient under age 35. However, a significant number of patients subsequently have nonfatal heart attacks and require repeat angioplasty or bypass grafting. The optimal approach for treating young CAD patients appears to be angioplasty and modification of lifestyle risk factors. (Consumer Summary produced by Reliance Medical Information, Inc.)