Percutaneous transluminal coronary angioplasty and subsequent restenosis: quantitative and qualitative methodology for their assessment.

ABSTRACT

Coronary arteriography is the most commonly used technique for documenting the immediate percutaneous transluminal coronary angioplasty result and for follow-up of the dilated arterial segment for restenosis within 6 months (which occurs in about 25% to 35% of cases). Acute success in dilation of the coronary lesion is likely if there is at least a resultant 1.3 mm2 minimum lumen area, equivalent to a 1.3 mm mean minimum lumen diameter, or about a 50% diameter stenosis of a typical proximal vessel. The measurement methods applied to this problem include a digital caliper, computer-assisted border recognition techniques and a video-densitometric approach to estimation of lumen area. Calipers are recommended because of their simplicity, precision and accuracy for the routine assessment of angioplasty result. Border-recognition techniques require considerable operator input to distinguish true flow channels from cul de sacs in the dissected segment. The automated scanning videodensitometry approach has theoretical appeal and has shown promise in preliminary reports; however, there is the potential for large measurement errors in the setting of dissection. Further, certain qualitative morphologic features of the dilated segment, such as longitudinal or transverse dissection or intraluminal thrombus, may effectively contribute to the prediction of acute complications and may be useful predictors of late restenosis. Because these features are best appreciated at increased arteriographic magnification, further high resolution studies will be necessary to better understand their importance.