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How to manage restenosis after angioplasty?

Q: My mother is 65 years old, with a history of NIDDM for 20 years, reasonably controlled; and essential hypertension for 25 years, well controlled. She underwent angioplasty - PTCA (60% block) 3 months ago and a stent was placed in the right coronary artery (RCA). She has developed pain again and the current diagnosis is stent occlusion due to ostial RCA and is being advised a repeat PTCA with a drug coated stent. An alternate opinion suggests that she be on medication only and does not undergo PTCA again. Please note that bypass surgery has been ruled out. I am confused and would like to know: 1) Is this a failure of the PTCA procedure? 2) What are the reasons for this re-occlusion immediately after the PTCA? 3) What is the prognosis ? 4) How can we improve the quality of life (which has deteriorated in lieu of the PTCA)?

A:This seems to be restenosis which can occur in certain percentage of patients (8-60% depending upon blockages) in first six months. This is due to uncontrolled healing process of inner lining of arteries after angioplasty. This process can be overcome by a drug coated stent to a reasonable degree. However one can treat her medically if her symptoms are controlled with medicines but if symptoms are not improved with medicines then angioplasty with drug coated stent is the choice for improving quality of life.

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