CABG术后症状复发患者的冠脉造影特征和缺血原因分析

目的:分析总结冠状动脉旁路移植术(CABG)术后症状复发患者的冠状动脉造影(CAG)特点,并探讨心肌缺血原因及其治疗对策。方法:对74例CABG术后心肌缺血复发患者行冠状动脉造影及桥血管造影。结果:74例患者中男性72例,女性7例,平均年龄(63.3±9.3)岁,平均复查时间(37.79±37.65)个月。74例患者共174支移植血管,其中左乳内动脉桥(LIMA)44支,大隐静脉桥126支,桡动脉桥4支。LIMA完全闭塞20.5%,狭窄18.2%;静脉桥闭塞40.5%,狭窄7.9%;4例桡动脉搭桥,2例有狭窄;竞争血流现象的发生率为12.2%;32.5%的患者自体冠脉病变加重;13.5%的患者存在再血管化不完全;CABG术后早期(1个月以内)心肌缺血的主要原因是LIMA吻合口狭窄(占50%),1年以内主要与静脉桥血管狭窄和闭塞有关(共占44.7%),而1年和5年以后则绝大多数缘于静脉桥的闭塞(占50%)。狭窄移植血管的PCI成功率接近90%。结论:CABG后部分患者移植血管可以发生狭窄或完全闭塞。移植血管病变是引起术后心肌缺血复发的主要原因。

Arteriographic characteristic and the causes of ischemia in patients with recurrence myocardial ischemia after CABG

Objective:To identify the causes of recurrence of myocardial ischemia and treatment after CABG. Methods:Performing coronary angiograme to Seventy-four patients with recurrence of myocardial ischemia after CABG.Result:Of the patients, there were seventy-two males and two females. The average age was( 63.39.3) years. The average duration from CAG to CABG was (37.7937.65) months. There were 44 LIMA grafts126 SV grafts and 4 radial grafts total. LIMA total occlusive rate was 20.5%, stenotic rate was 18.2%. Stenosis and total occlusion was found in 7.9% and 40.5% respectively of the SV graft. Two-fourth of radial grafts has stenotic lesions. Competitive flow was found in 12.2% of the patients, the worsened native coronary arteries in 17.6% and incomplete revascularization in 13.5%. 1 patient has wrong graft site. The main causes of myocardial ischemia was graft lesions. The successful rate graft vessels PCI was 90%.Conclusion:The main causes of ischemia was graft lesions and graft PCI with stenosis lesions showed a higher successful rate.