冠状动脉旁路移植术后桥血管病变及预防措施

对于冠状动脉左主干和多支血管严重病变者,外科手术仍然是目前主要的治疗手段.自体静脉是冠状动脉旁路移植术的主要桥血管材料,临床上最为常用的是自体大隐静脉.自体大隐静脉虽然来源丰富取材方便,但有术后桥血管再狭窄或闭塞等诸多问题.本文综述静脉桥血管病变的病理机制及其防治措施,为临床工作提供参考.     

冠状动脉旁路移植术后旁路移植血管病变介入治疗的临床疗效

目的　探讨旁路移植血管病变的特点及介入治疗旁路移植血管病变的临床疗效。方法　对 30例 35处旁路移植血管病变行介入治疗 ,其中大隐静脉移植血管病变 31处 ,内乳动脉移植血管病变 4处。结果　临床成功率为 96 7% ,病变的成功率为 97 1% ,无再流发生率为 7 4 % ,术中和住院期间无一例死亡 ,1例术后发生急性心肌梗死与无再流有关 ,住院期间并发症 (死亡、急性心肌梗死、紧急血管重建 )发生率仅为 3 3%。结论　本研究结果提示介入治疗旁路移植血管病变是冠状动脉旁路移植术后心肌缺血的有效治疗手段。     

冠状动脉旁路移植术后桥血管病变及预防措施

对于冠状动脉左主干和多支血管严重病变者,外科手术仍然是目前主要的治疗手段。自体静脉是冠状动脉旁路移植术的主要桥血管材料,临床上最为常用的是自体大隐静脉。自体大隐静脉虽然来源丰富取材方便,但有术后桥血管再狭窄或闭塞等诸多问题。本文综述静脉桥血管病变的病理机制及其防治措施,为临床工作提供参考。     

冠状动脉旁路移植术后病变桥血管的介入治疗

目的探讨冠状动脉旁路移植(CABG)术后移植血管病变介入治疗的效果。方法对CABG术后旁路移植血管的病变进行介入治疗。术后即刻进入临床随访,记录心脏事件的发生,患者术后6个月复查造影。结果对66例患者的74支病变桥血管(83处病变)进行了介入治疗,造影成功率为96.97%(64/66),临床成功率95.45%(63/66)。术中出现无复流现象2例,1例经处理恢复血流,1例处理无效。远端栓塞1例,D型夹层造成血管急性闭塞1例,重新置入支架后成功。住院期间无心脏事件发生。64例患者完成6个月的临床随访,心脏事件发生率为31.3%(20/64)。37例患者接受了造影检查,支架内再狭窄发生率为32.5%(13/40)。结论桥血管病变的介入治疗是可行、安全和有效的。     

冠状动脉旁路移植术后桥血管造影特点分析

目的总结冠状动脉旁路移植术(CABG)后桥血管造影特点,分析相关因素对桥血管通畅率的影响。方法选择2004年4月至2006年4月我院CABG术后因心绞痛复发再入院行冠状动脉造影(CAG)的256例患者,男性218例,平均年龄(61.2±9.7)岁。CABG到复查CAG的间隔时间(50.9±40.1)个月。共722支桥血管,其中左乳内动脉(LIMA)桥215支,大隐静脉(SV)桥485支,左桡动脉(RA)桥19支,右乳内动脉(RIMA)桥3支。桥血管造影完全闭塞或狭窄≥75%视为桥血管病变。结果31.6%(228/722)的桥血管发生病变。LIMA桥病变率13.5%(29/215),SV桥病变率39.2%(190/485),RA桥病变率42.1%(8/19),RIMA桥病变率33.3(%1/3)。术后1年内LIMA桥和SV桥病变率分别达14.6%和32.9%,之后随时间缓慢增加。不同靶血管的SV桥通畅率有明显差别。手术年龄<50岁者桥血管病变率增加。性别、序贯吻合及综合危险因素对桥血管通畅率无明显影响。结论CABG术后桥血管病变较常见,是造成术后心绞痛复发的重要原因。LIMA桥的通畅率明显优于SV桥。不同桥血管、不同靶血管、手术年龄均明显影响桥血管通畅率。     

冠状动脉旁路移植术后桥血管再狭窄治疗进展

冠状动脉旁路移植术后桥血管再狭窄问题值得临床关注,现主要对其相关治疗进展,包括药物治疗、基因治疗、再次手术治疗及介入治疗作一综述.     

冠状动脉旁路移植术患者桥血管闭塞自身血管病变介入治疗

目的 探讨对冠状动脉旁路移植术(CABG)后桥血管闭塞患者自身冠状动脉行经皮冠状动脉介入治疗(PCI)的疗效.方法 2003年6月至2007年6月135例CABG后,再次出现心绞痛且1支或2支桥血管闭塞患者入选.患者CABG后至复查冠状动脉造影时间为4～89(平均33.8±23.5)个月.移植血管共318支,闭塞146支,其中左内乳动脉(LIMA)闭塞29支(29/128),占22.7%,大隐静脉桥闭塞117支(117/188),占62.2%.自身靶血管146支,靶病变158处,均为B2或C型病变,其中在45例患者有47处慢性完全闭塞病变(CTO)(47/158),占29.7%.结果 对135例患者共158处自身冠状动脉靶病变进行PCI,其中对45例患者的47处CTO进行了PCI,共置入310枚药物洗脱支架(DES),未置入裸支架.总病例成功率为96.3%(130/135),病变成功率为96.8%(153/158).术后住院期间所有患者均无主要临床并发症发生.术后12个月再狭窄率5.6%(5/89),靶血管重建率5.4%(7/130),心脏不良事件发生率为6.2%(8/130).结论 对CABG后桥血管闭塞患者自身冠状动脉行PCI成功率高,并发症发生率低、疗效好.     

冠状动脉旁路移植术后桥血管转归及影响因素

冠状动脉(冠脉)旁路移植术(CABG)仍是复杂冠脉病变主要的治疗方法,但术后桥血管往往有再狭窄或闭塞等病变,桥血管病变也是造成术后缺血症状复发的主要原因,因此综述分析移植血管的病变特征、转归和影响因素,对桥血管病变的防治具有重要的临床指导意义。     

冠状动脉旁路移植术后桥血管支架置入术2例

例1男,64岁,冠心病病史5年,1999年因3支弥漫病变及左主干(LM)病变行冠状动脉旁路移植术(CABG),术后第3天出现急性前壁心肌梗死,于2000年6月因频繁心绞痛入院。入院体检心肺无阳性体征,心电图符合前壁陈旧性心肌梗死(OMI)改变,超声心动图示前壁搏动减弱,符合前壁OMI改变,心功能正常。入院后行冠状动脉造影,结果示:左前降支(LAD)近端100%关闭,LAD远端与内乳动脉吻合口处90%狭窄,左回旋支(LCX)中远端70%狭窄,LM开口50%狭窄,右冠状动脉(RCA)中远端不规则病变,主动脉根部到RCA远端搭桥血管通畅。对前降支与内乳动脉吻合口狭窄处进行…     

冠状动脉旁路移植术后的原位血管介入治疗

目的针对冠状动脉旁路移植术后在原位血管进行介入治疗的疗效研究。方法我中心对2004年4月至2009年4月在我院或外院曾行冠状动脉旁路移植术后因胸闷痛症状反复发作并复查冠状动脉造影及支架植入术的10例患者进行了回顾性分析。将患者分为两组:原位血管介入组;静脉桥血管介入组。结果桥血管PCI组:2例因再次心绞痛发作住院治疗,1例硝酸甘油用量同术前没有明显改变,1例随访1年内未出现心绞痛症状,活动耐量逐渐增加。原位血管PCI组:随访1年期间内无因再发心绞痛再次住院的,其中2例患者门诊随诊心绞痛仍有反复,但硝酸甘油用量同术前相比明显减少服用次数,其余4例患者心绞痛症状缓解明显,硝酸甘油用量明显减少,活动耐量明显增强。结论对冠状动脉旁路移植术后再发心绞痛患者进行介入治疗时,尽可能选择干预原位血管病变。     

Initial results and long-term outcome of percutaneous coronary intervention in patients with previous coronary artery bypass grafting

OBJECTIVES: The incidence of percutaneous coronary intervention following bypass surgery(coronary artery bypass grafting: CABG) is not low, but the outcomes of patients requiring percutaneous coronary intervention after CABG are not well known. METHODS: From June 1970 to June 2000, 2,981 patients underwent CABG at our institute using 6,747 grafts including 2,875 saphenous vein graft(SVG), 3,042 internal thoracic artery(ITA), 706 gastro-epiploic artery(GEA), 122 radial artery(RA), and 2 others. Three hundred twenty-seven patients underwent subsequent percutaneous coronary intervention in 520 lesions(104 SVG, 97 ITA, 12 GEA, 8 RA, 299 native artery). The initial results and long-term outcome following percutaneous coronary intervention in these 520 consecutive procedures were evaluated retrospectively. RESULTS: Percutaneous coronary intervention to arterial grafts were performed mainly within the early post-operative period, whereas percutaneous coronary intervention to vein grafts had two periodic peaks in the early post-operative period and at 7 years after CABG. Procedural success rate of percutaneous coronary intervention was 90% for SVG, 81% for ITA, 58% for GEA, 88% for RA, and 87% for native arteries. Restenosis rate was 56% for SVG, 30% for ITA, 83% for GEA, 83% for RA, and 49% for native arteries. Cardiac events after percutaneous coronary intervention with previous CABG were greater in cases of ITA, followed by native arteries, SVG, GEA and RA(p = 0.0046). In the early post-operative period, there was no significant difference between ITA and SVG. In the chronic stage, the prognosis of cardiac events after PCI for SVG was worse than for ITA. CONCLUSIONS: Percutaneous coronary intervention after CABG requires strategic consideration based on target-specific initial results and long-term outcome.     

Strategy for post coronary artery bypass grafting in patients with bypass graft stenosis: comparison of percutaneous transluminal coronary angioplasty for the native coronary artery, internal mammary artery and saphenous vein graft]

OBJECTIVES: The strategy for post coronary artery bypass grafting (CABG) was investigated in patients with graft stenosis. METHODS: The study included 123 post-CABG patients with graft stenosis. The patients were divided into three groups according to target vessels; saphenous vein graft (SVG; n = 72), internal mammary artery (IMA; n = 21) and native coronary artery (n = 30). Furthermore, SVG lesions were divided into proximal anastomosis (n = 23), body (n = 40) and distal anastomosis (n = 9). The procedural success rate and late patency rate were compared between the three groups. Furthermore, the relationships between pre percutaneous transluminal coronary angioplasty (PTCA) percentage diameter stenosis, procedural success rate and late patency rate were evaluated. RESULTS: Procedural success rate was similar in the three groups, but late patency rate was higher in the IMA group. Procedural success rate and late patency rate were significantly lower in proximal anastomoses compared to other sites of SVG stenoses, IMA group and native coronary artery group (p < 0.05). Totally occluded native coronary artery lesions had a high procedural success rate compared with occluded IMA and SVG lesions, but the late patency rate was not higher. Procedural success rate showed no significant difference for 75-99% stenotic lesions, but the late patency rate was significantly higher in the IMA group (p < 0.05). Patients in the stenting group had a greater late patency rate compared with the balloon angioplasty group. There was no significant difference in late patency rate between the IMA group and SVG group. CONCLUSIONS: Late patency rate of the IMA is higher than that of the native coronary artery. SVG with proximal anastomosis and severe stenosis shows a significantly lower late patency rate than the native coronary artery. Therefore, PTCA should be considered for the native coronary artery in the absence of chronic total occlusion.     

冠状动脉搭桥与冠脉介入治疗的比较

冠状动脉旁路移植术（CABG）和经皮冠状动脉介入术（PCI）是目前治疗冠状动脉狭窄的两种主要治疗方法。CABG是半个世纪以来治疗冠心病经典手段之一,近年来由于对桥血管的选择和保护、全动脉再血管化等的重视,其近远期治疗效果明显提高。随着介入技术的发展,这项技术以其微创、安全、易于被患者所接受等特点,适应证不断扩大。本文就近年来CABG和PCI在治疗冠心病方面的发展和优势作一综述。     

冠状动脉旁路移植术后行PCI患者特点分析

目的:探讨冠状动脉旁路移植术后行经皮介入治疗(PCI)患者的临床及造影特点,为冠脉旁路移植术后患者治疗策略的选择提供参考. 方法:分析150例搭桥术后行PCI患者的临床及造影特点. 结果:患者平均年龄(62.3±9.3)岁,左室射血分数(59.1±6.6)％.150例患者均为冠状动脉多支血管病变,共处理罪犯病变197处,其中自身血管153处,动脉桥血管2处,静脉桥血管42处.所有患者均行PCI治疗,无再流发生率为12.7％,其中16例为桥血管病变,3例自身冠状动脉病变,桥血管介入治疗较自身血管介入治疗后其心肌标志物升高明显,无术中死亡病例. 结论:PCI是冠状动脉搭桥术后心肌缺血患者的有效治疗手段,心功能和血管病变造影特点是成功治疗的关键.     

Patient preferences for coronary artery bypass graft surgery or percutaneous intervention in multivessel coronary artery disease

Objectives: Determine if patients prefer multivessel percutaneous coronary intervention (mv‐PCI) over coronary artery bypass graft surgery (CABG) for treatment of symptomatic multivessel coronary artery disease (mv‐CAD) despite high 1‐year risk. Background: Patient risk perception and preference for CABG or mv‐PCI to treat medically refractory mv‐CAD are poorly understood. We hypothesize that patients prefer mv‐PCI instead of CABG even when quoted high mv‐PCI risk. Methods: 585 patients and 31 physicians were presented standardized questionnaires with a hypothetical scenario describing chest pain and medically refractory mv‐CAD. CABG or mv‐PCI was presented as treatment options. Risk scenarios included variable 1‐year risks of death, stroke, and repeat procedures for mv‐PCI and fixed risks for CABG. Participants indicated their preference of revascularization method based on the presented risks. We calculated the odds that patients or physicians would favor mv‐PCI over CABG across a range of quoted risks of death, stroke, and repeat procedures. Results: For nearly all quoted risks, patients preferred mv‐PCI over CABG, even when the risk of death was double the risk with CABG or the risk of repeat procedures was more than three times that for CABG (P < 0.0001). Compared to patients, physicians chose mv‐PCI less often than CABG as the risk of death and repeat procedures increased (P < 0.001 and P = 0.004, respectively). Conclusion: Patients favor mv‐PCI over CABG to treat mv‐CAD, even if 1‐year risks of death and repeat procedures far exceed risk with CABG. Physicians are more influenced by actual risk and prefer mv‐PCI less than patients despite similarly quoted 1‐year risks. © 2013 Wiley Periodicals, Inc.     

Initial success rate of percutaneous coronary intervention for chronic total occlusion in a native coronary artery is decreased in patients who underwent previous coronary artery bypass graft surgery

Objectives This study sought to compare the initial success rate of percutaneous coronary intervention(PCI)for chronic total occlusion(CTO) in a native coronary artery(NCA) in patients with and without previous coronary artery bypass grafting(CABG) and to assess predictive factors. Background Landmark novel wiring techniques for CTO-PCI have contributed to improvement in the initial success of CTO-PCI. However,challenges persist in CTO-PCI in NCA in pCABG patients. Methods Patients who underwent CTO-PCI in an NCA were selected and classified into 2 groups: pCABG(206 PCIs in 153 patients) and nCABG(1,431PCIs in 1,139 patients). Results CTO was located more often in the left anterior descending artery(P =0.0003), and severe calcified lesions were observed more frequently in the pCABG group(P 0.0001). Although the retrograde attempt was tried more frequently in the pCABG group, the CTO-PCI success rate was significantly lower in the pCABG patients than in the nCABG patients(71% vs. 83%). Longer procedural time and greater radiation exposure were needed in the pCABG patients. Logistic regression analysis among the pCABG patients revealed that intravascular ultrasound use and parallel wiring were positive factors, and lesion tortuosity was a negative factor. Conclusion The initial success rate of CTO-PCI of an NCA in the pCABG group was significantly decreased compared with that in the nCABG group. Anatomic complexity and unstable hemodynamic state were unfavorable conditions. This study reveals that the issues to be overcome are lying with CTO revascularization in an NCA in pCABG patients.