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What are the long-term results of percutaneous coronary intervention?
Long-term benefits of percutaneous coronary intervention depend on the maintenance of the newly-opened coronary artery(ies). Thirty to fifty percent of patients with successful balloon angioplasty (no stent) may develop recurrent narrowing (restenosis) at the site of the balloon inflation, usually within six months following percutaneous coronary intervention. Patients may complain of recurrence of angina or may have no symptoms. Restenosis is often detected by exercise stress tests performed at four to six months after percutaneous coronary intervention. Restenosis occurs with a significantly higher frequency in people with diabetes. The rate of restenosis is greater in vein grafts, at the origins of vessels, in the beginning part of the left anterior descending coronary artery, and in those with suboptimal initial results. The widespread use of intracoronary stents has reduced the incidence of restenosis by as much as 50% or more; this is due to prevention of "elastic recoil" in the artery, as well as providing a larger initial channel in the treated artery. With the newer medicated stents, the restenosis rate is well under 10%.
Restenosis can simply be observed or treated with medications if the narrowing is not critical and the patient is not symptomatic. Some patients undergo a repeat percutaneous coronary intervention to increase coronary artery blood flow. Second percutaneous coronary intervention procedures have similar initial and long-term results as first procedures, although certain patterns of restenosis have a very high repeat recurrence rate. Sometimes, CABG surgeries are recommended for those patients who have developed more extensive disease in the restenosed artery as well as in the other coronary arteries. Patients may also choose CABG surgery to avoid the uncertainty of restenosis after the second percutaneous coronary intervention. In patients with restenosis after balloon angioplasty or stents, the use of intracoronary radiation (brachytherapy) may reduce the risk of future restenosis. If no evidence of restenosis is observed after six to nine months, studies have demonstrated that the treated arterial segment is likely to remain open for many years. "Late restenosis" after one year or more is very uncommon. Symptoms developing more than one year after successful percutaneous coronary intervention are usually due to blockage in a different segment of the artery or in a different artery from that which was treated in the initial percutaneous coronary intervention.