'Tandem lesion' coronary angioplasty: ten years' experience.

Background: To evaluate the acute and long-term results of 'tandem lesion' coronary angioplasty in the left anterior descending artery, and to identify the determinants of restenosis.

Methods: A retrospective analysis of clinical, angiographic, and procedure-related variables was carried out on a consecutive series of 102 patients (mean age 54 years, range 34-71 years; 77% men) who had undergone tandem lesion coronary angioplasty in the left anterior descending artery (204 lesions) between 1981 and 1991.

Results: Angiographic success was achieved in 96 patients (94%) and 195 lesions (96%). Clinical success was achieved in 91 patients (89%). Five patients (5%) suffered a non-fatal Q-wave myocardial infarction. No procedural deaths occurred. Complete follow-up data were available for all 102 patients (median 46 months, range 1-122 months). During the follow-up period, two patients (2%) died, two (2%) suffered non-fatal myocardial infarction, and 18 (18%) underwent a second revascularization procedure. The cumulative probability of survival was 98.9% and 97.8% at 1 and 5 years respectively. Survival free from myocardial infarction, bypass surgery and repeat angioplasty at 1 and 5 years was 80.8% and 74.9% respectively. Thirty patients underwent repeat angiography (mean 8.8 months) for symptoms or evidence of reversible ischaemia. Restenosis occurred at a single dilated site in 14 patients and at both sites concurrently in six patients. Eight patients had no restenosis but two had total occlusion of the left anterior descending artery. Multiple logistic regression analysis identified increased inflation frequency as the only independent predictor of restenosis.

Conclusions: Tandem lesion coronary angioplasty of the left anterior descending artery can be performed with a high primary success rate and favourable long-term outcome. The fact that restenosis occurred at a single site more often than at both, suggests that systemic factors are less important than local factors in influencing restenosis.