Definition of Restenosis after Percutaneous Transluminal Coronary Angioplasty: A Quickly Evolving Concept

Symptoms, Function, or Anatomy as Criteria of Restenosis? The incidence of late restenosis has remained much the same over the 13 years that angioplasty has been part of clinical practice and there is still no proven intervention that modifies the restenosis process.' Primary success and restenosis after percutaneous transluminal coronary angioplasty (PTCA) may be defined by symptomatic criteria such as frequency and severity of anginal episodes, by functional criteria such as pressure flow characteristic of the dilated vessel, coronary flow reserve and various noninvasive diagnostic tests, or may be defined by anatomic criteriausing postmortem histology, angiography, or intervascular ultrasound. These three criteria may be considered separately or may be interrelated so that the definition of restenosis becomes a complex issue. About the symptomatic criteria, it is fair to emphasize the four following points. ( 1 ) Although the subjective improvement of symptoms after PTCA is probably the most desirable endpoint, it is also the least objective evaluation.2 (2) The frequency of symptomatic improvement appears to be lower than that of angiographic success: