经桡动脉和经股动脉介入治疗静脉桥血管病变的比较研究

目的:比较经桡动脉介入治疗(TRI)和经股动脉介入治疗(TFI)静脉桥血管病变的临床疗效.方法:研究对象为我院2006-01至2009-12的31例TRI(桡动脉组)和115例TFI(股动脉组)的静脉桥血管病变患者,比较TRI和TFI患者临床特征、操作特点及住院期间临床疗效.结果:桡动脉组和股动脉组的X线曝光时间[(15.6±3.7)分比(14.5±3.4)分]、操作时间[(34.6±15.2)分比(37.4±18.8)分]、造影剂用量[ (225±120) ml比(263±130)ml],差异均无统计学意义(P均＞0.05).桡动脉组与股动脉组操作成功率(93.5％比95.6％,P＞0.05),差异无统计学意义;而股动脉组血管径路并发症较桡动脉组显著增加(3.2％比15.7％,P=0.04),差异有统计学意义.桡动脉组和股动脉组住院期间主要不良心脏事件(0％比2.0％)、死亡(0％比0％)、心肌梗死(0％比0.9％)、靶病变血运重建(0％比0.9％)发生率均类似,差异均无统计学意义(P均＞0.05).结论:与TFI相比,TRI静脉桥血管病变安全有效,且血管径路并发症明显减少,但造影与介入同期完成比例较少.     

冠状动脉旁路移植术后2型糖尿病患者接受自身血管或静脉桥介入治疗预后的比较

目的：比较冠状动脉旁路移植术（coronary artery bypass graft,CABG）后的2型糖尿病（type 2 diabetes mellitus,T2DM）患者选择自身血管或静脉桥行经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）对患者预后的影响,并探讨该类患者发生主要不良心脑血管事件（major adverse cardiac and cerebrovascular events,MACCE）的预测因素。方法：筛选了CABG术后需再次行PCI治疗的T2DM患者559例,其中488例患者接受自身血管PCI,71例患者接受静脉桥PCI。比较不同靶血管的选择对预后的影响,并采用多因素Cox回归分析发生MACCE的预测因素。主要研究终点为MACCE。结果：与自身血管PCI组相比,静脉桥PCI组患者慢血流/无复流的发生风险更高（2.8%vs.零,P=0.008）。中位随访40个月发现自身血管PCI组与静脉桥PCI组患者发生MACCE的风险相似（35.2%vs. 33.8%,P=0.916）,并且两组患者发生其他终点事件,差异...     

准分子激光冠状动脉内斑块消蚀术在大隐静脉桥血管病变介入治疗中的应用分析

目的：观察准分子激光冠状动脉内斑块消蚀术（ELCA）在冠状动脉旁路移植术后大隐静脉桥血管（SVG）病变经皮冠状动脉介入治疗（PCI）中应用的安全性和有效性。方法：总结2020年5月至2021年5月在云南省阜外心血管病医院冠心病中心应用ELCA治疗的5例大隐静脉桥血管病变PCI患者,导引钢丝通过SVG病变,应用血管内超声评价SVG病变特征,ELCA治疗后进行药物洗脱支架置入或药物洗脱球囊处理。观察手术成功率及并发症,并随访复发性心绞痛、心肌梗死、靶血管重建及心原性死亡等主要不良心脏事件（MACE）发生情况。结果：5例患者ELCA辅助SVG病变PCI全部成功,术中无1例发生血管夹层、穿孔、慢血流及无复流,随访期间无1例发生复发性心绞痛、心肌梗死、靶血管重建及心原性死亡。结论：应用ELCA辅助SVG病变行PCI安全有效,可显著减少相关并发症,改善预后。     

冠状动脉旁路移植术后静脉桥血管阻塞病变的经皮介入治疗进展

慢性完全闭塞性冠状动脉（冠脉）病变、分叉病变、支架内再狭窄、冠脉旁路移植术（CABG）后静脉桥血管（saphenous vein bypass graft，SVBG）阻塞的介入治疗，是当今经皮冠脉介入治疗的几个主要难题。伴随CABG术后再次心肌缺血患的增多，已有国内学关注到SVBG病变的介入治疗问题。     

经皮冠状动脉介入治疗64例静脉桥血管病变的临床疗效

目的 评价静脉桥血管经皮冠状动脉介入治疗及支架治疗后的早期临床结果。方法对64例91处大隐静脉桥血管病变行介入治疗,将术中及住院期间的临床结果和术中应用的其他介入治疗辅助装置一并录入数据库并进行分析。结果手术成功率95．3％;术中发生非Q波心肌梗死1例(1．6％)。一过性无再流现象4例(6．3％),其中1例置人支架后无再流而出现室颤,经电除颤、心脏按压、气管插管及置入主动脉内气囊反搏装置后血流恢复正常。应用血管远端保护装置7例(10．9％),X-sizer取栓系统4例;术中或术后应用血小板GPⅡb／Ⅲa受体拮抗剂25例(39．1％)。住院期共发生非Q波心肌梗死2例,主要心脏不良事件发生率为3．1％。结论静脉桥血管的经皮冠状动脉介入加支架治疗的即刻成功率高,近期临床效果满意,中、远期结果有待进一步随访;血管远端保护装置和血小板受体拮抗剂的应用有可能改善预后。     

CABG术后大隐静脉桥血管的PCI术相关问题

大隐静脉桥（SVG）病变是冠状动脉旁路移植（CABG）术后患者心绞痛复发的主要原因,经皮介入治疗（PCI）是治疗SVG的常用方法.SVG病变往往为较大、松软、易碎的斑块,内含大量坏死组织、胆固醇结晶、泡沫细胞以及血细胞成分,因此PCI面临的包括术中远段血管栓塞等并发症高、术后再狭窄率高以及临床MACE发生率高等问题.早期的SVG介入治疗经验主要参考了自体冠脉的PCI,如球囊预扩张后植入支架、高压释放支架、使用GPⅡb/Ⅲa受体拮抗剂等,但是近年的循证医学研究主张对于SVG行PCI应采用直接支架术及小直径支架低压释放,术中采用远端保护装置等.     

远端保护装置FilterWire EXTM在冠状动脉旁路移植术后大隐静脉桥病变介入治疗中的临床效果

目的 远端血栓栓塞是冠状动脉旁路移植术后大隐静脉桥的介入治疗过程中常见的并发症,本研究在大隐静脉桥病变的介入治疗中应用新颖的FilterWire EXTM远端保护装置,评价其临床疗效与安全性。方法 选择73例冠状动脉旁路移植术后大隐静脉桥病变患者为研究对象。其中39例患者在FiherWire EXTM的保护下行介入治疗(FilterWire EXTM组),而另34例患者进行无保护的常规介入治疗(对照组)。比较两组患者介入治疗前后的FIMI血流,院内及30 d心脏不良事件发生率。结果 Filter-Wire EXTM在全部病例均成功释放。FiherWire EXTM组经皮冠状动脉介入治疗后TIMI3级血流发生率显著高于对照组(89.74％比76.47％,P<0.05),“无血流”(TIMI 0/1级血流)或“慢血流”(TIMI 2级血流)发生率显著低于对照组(分别为2.56％比8.82％及7.69％比14.70％,P<0.05),院内及30 d心脏不良事件发生率均显著降低(7.69％比17.65％及5.13％比14.71％,P<0.05);未见与装置有关的并发症。结论 在大隐静脉桥病变的介入治疗中联合应用FilterWire EXTM远端保护装置可安全有效,简便易行地预防远端血栓栓塞并发症的发生,显著降低患者院内及30 d心脏不良事件发生率。     

CABG术后大隐静脉桥血管的PCI术相关问题

大隐静脉桥(SVG)病变是冠状动脉旁路移植(CABG)术后患者心绞痛复发的主要原因,经皮介入治疗(PCI)是治疗SVG的常用方法.SVG病变往往为较大、松软、易碎的斑块,内含大量坏死组织、胆固醇结晶、泡沫细胞以及血细胞成分,因此PCI面临的包括术中远段血管栓塞等并发症高、术后再狭窄率高以及临床MACE发生率高等问题.早期的SVG介入治疗经验主要参考了自体冠脉的PCI,如球囊预扩张后植入支架、高压释放支架、使用GPⅡb/Ⅲa受体拮抗剂等,但是近年的循证医学研究主张对于SVG行PCI应采用直接支架术及小直径支架低压释放,术中采用远端保护装置等.     

115例冠状动脉闭塞病变介入治疗的临床分析

目的 探讨亚急性、慢性闭塞性冠状动脉病变经皮腔内冠状动脉成型术(PTCA)及支架置入术的临床疗效。方法对115例行PTCA术的冠状动脉闭塞病例(115支闭塞血管)的临床资料进行回顾性分析。根据冠状动脉闭塞的时间将病人分为二组:43例为亚急性闭塞组(1-30d),72例为慢性闭塞组(1-108月),均按常规行PTCA及支架置入术操作。结果两组病人的性别、年龄、冠心病的易患因素、病变支数、闭塞血管部位等无明显差异。亚急性闭塞组心肌梗死发生率为65％,明显高于慢性闭塞组9％;慢性闭塞组不稳定型心绞痛发生率为91％,明显高于亚急性闭塞组35％。亚急性闭塞组导丝通过率97％,球囊扩张率97％,支架置入率为95％。慢性闭塞组导丝通过率90％,球囊扩张率87％,支架置入率为85％。结论本研究表明闭塞血管的介入治疗是安全有效的,亚急性闭塞组成功率高于慢性闭塞组。急性并发症发生率很低。手术的成功与闭塞的时间、造影的特点、器械的选择以及术者的技术有关。     

Long term outcomes of saphaneous vein graft intervention in elderly patients with prior coronary artery bypass graft

Objectives To investigate the procedure characteristics and long term follow-up ofpercutaneous coronary intervention （PCI） for sa phaneous vein graft （SVG） lesions in the elderly patients. Methods From December 2005 to December 201 l, 84 graft lesions were treated percumneously. Seventeen were located at proximal anastomosis, 48 were located at SVG body, 19 were located at distal anastomosis. Pri mary endpoint was defined as major adverse cardiovascular events （MACE, composite of cardiac death, target vessel revascularization, acute myocardial infarction）. Results The graft age was 6.7 i 4.0 years. Most anastomosis lesions （80.0%） presented within one year post coro-nary artery bypass grafting （CABG）. Proximal anastomosis lesion had the lowest successful rate for PCI compared with graft body and distal anastomosis lesions （70.6% vs. 91.7%, 79.0%, P 〈 0.05）. The distal embolic protection device was used in 19.1% of patients, most frequently used in body graft PCI （29.2%, P 〈 0.01）. The diameter of the stent was smallest in distal anastomosis group （2.9 ±0.4 mm, P 〈 0.05）. The highest post dilatation pressure was required in the proximal anastomosis （17.8 ± 2.7 atm, P 〈 0.05）. The patients were followed up for 24.3 ±16.9 months. MACE occurred in 18.57% of patients. Incidence of MACE was highest among proximal anastomosis PCI （47.1% vs. body graft PCI 16.7%, distal anastomosis PCI 21.1%; P 〈 0.05）. Old myocardial infarction was the predictive factor for the poor clinical outcomes （P〈 0.04）. Conclusions PCI of SVG lesions is feasible with lower success rate. PCI of ostial graft anastomosis lesions had the lowest procedure success rate and highest MACE rate compared with graft body and distal anastomosis lesions. Old myocardial infarction was a predictive factor of poor outcomes.     

Outcomes of patients with acute myocardial infarction rom a saphenous vein graft culprit undergoing percutaneous coronary intervention

Objectives : We sought to describe characteristics of patients presenting with an acute MI from a SVG culprit, compared with a native culprit. Background : Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVG) results in worse outcomes than native vessel PCI, but outcomes of such patients with acute myocardial infarction (MI) setting are not well‐described. Methods : Patients presenting with ST‐elevation or non‐ST‐elevation MI undergoing PCI from 2000 to 2010 were retrospectively analyzed to identify the culprit as a SVG vs. native vessel. Multiple linear regression was used to identify predictors of peak troponin‐I level. Cox proportional hazards regression was used to identify predictors of 30‐day mortality and 1‐year major adverse cardiac events (MACE). Results : 192 patients underwent PCI for a SVG culprit, compared with 4,001 with a native culprit. After multivariable adjustment, SVG culprit remained significantly associated with lower levels of the logarithm of the peak troponin (β = ?0.17, SE = 0.07, P = 0.02). The likelihood of MACE was higher in SVG vs. native culprits in patients with small to modest troponin elevations. Patients with a SVG culprit also suffered higher unadjusted rates of mortality at 30 days (14.3% vs. 8.4%, P = 0.03) and MACE at 1 year (36.8% vs. 24.5%, P = 0.005); a modest effect upon mortality and MACE remained after multivariable adjustment. Conclusion : Even minimal elevations of troponin in patients with a SVG culprit may portend a poorer prognosis than in patients with a native culprit. The risk of PCI in this setting is driven by mortality and arises from both substantial comorbidities and the SVG itself. © 2011 Wiley‐Liss, Inc.     

Percutaneous coronary intervention of a saphenous vein graft ostial stenosis in a patient with Bentall procedure

Composite graft replacement of the aortic root and coronary reimplantation with or without coronary artery bypass surgery is the standard treatment for a variety of aortic root pathologies. Previously, percutaneous coronary intervention of either reimplanted coronary arteries or left/right coronary artery through cabrol graft has been described in post-Bentall patients. We describe percutaneous coronary intervention of a saphenous vein graft ostial stenosis in a patient with previous Bentall procedure and a vein graft to right coronary artery, which was complex and challenging.     

Combined use of retrograde myocardial and distal coronary protection for last vessel intervention in an aortocoronary vein graft.

Feasibility, safety, and clinical efficacy of the combined application of the PercuSurge system and the Myoprotect SSR device was demonstrated in a patient with high-risk anatomy undergoing saphenous vein graft intervention. This combined approach of coronary and myocardial protection may be considered in high-risk aortocoronary vein graft interventions.     

A large saphenous vein graft aneurysm presenting as a right atrial mass: a case report

An aneurysm of a saphenous vein graft (SVG) is a rare but potentially fatal complication of coronary artery bypass grafting (CABG). We describe a case of a large SVG aneurysm (7 x 6 cm) compressing the right atrium. The patient presented with chest pain, dyspnea and desaturation, and a right intra-atrial mass was revealed on echocardiography. The differential diagnosis of intracardiac masses revealed by echocardiography should include extrinsic lesions. Due to its potential lethal complications, an SVG aneurysm should be considered in a post-CABG patient presenting with acute coronary syndrome or heart failure.     

Clinical outcomes after sirolimus-eluting stent implantation for de novo saphenous vein graft lesions.

The purpose of this study was to evaluate the clinical outcome of patients undergoing sirolimus-eluting stent implantation for de novo lesions within saphenous vein grafts (SVGs). Although the incidence of restenosis following sirolimus-eluting stenting (SES) of native coronary arteries is low, the efficacy of SES to treat de novo lesions within SVGs has not been well studied. A total of 35 patients underwent SES implantation of 39 lesions during 36 procedures. All patients had a minimum follow-up of 6 months following the index procedure. The mean bypass graft age was 10.1 +/- 6.5 years (range, 0-23 years). In-hospital major adverse cardiac events [death, myocardial infarction, thrombosis, or target vessel revascularization (TVR)] occurred in four patients (11%). Clinical follow-up was obtained in 100% of patients (mean follow-up, 7.5 +/- 2.2 months). There was one cardiac death, presumed due to stent thrombosis. TVR occurred in only two patients (6%). Myocardial infarction (MI) occurred in four patients (11%), all attributable to a nontarget vessel. The combined endpoint of death, MI, or TVR occurred in seven patients (20%). Freedom from death, nonfatal MI, thrombosis, or any revascularization was 65%. Early experience indicates sirolimus-eluting stents for de novo saphenous vein graft lesions have a low (6%) rate of clinically driven target vessel revascularization. By 7-month follow-up, event-free survival is limited primarily by disease in nontarget vessels.     

急性冠状动脉综合征的急诊介入治疗

目的评价急诊冠状动脉内介入治疗急性冠状动脉综合征的疗效和安全性。方法急性冠状动脉综合征患者87例,男72例,女15例。年龄37～82岁。其中ST段抬高心肌梗死62例,非ST段抬高心肌梗死和不稳定型心绞痛25例,行急诊冠状动脉内介入治疗,分析其临床表现,冠状动脉病变特点,处理以及并发症和预后。结果87例患者共成功置入支架169枚,其中直接支架术53次,经皮冠状动脉腔内成形术加支架术116次。单纯冠状动脉腔内成形术22次。有16例患者行血管内超声指导冠状动脉内介入。手术成功率96．5％,住院期间死亡1例。随访5～22月,生存率98.8％,无事件生存率86．0％。院外猝死1例,心肌梗死1例,心绞痛再发10例。结论急诊冠状动脉内介入治疗急性冠状动脉综合征安全有效,有助于改善预后。