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.

Outcome of percutaneous coronary intervention of graft occlusion post coronary artery bypass graft

Objective To evaluate the feasibility and efficacy of percutaneous coronary intervention (PCI) for graft occlusion post coronary artery bypass graft(CABG).Methods The clinical data of 135 post-CABG patients with bypass graft occlusion and angina peetoris symptoms admitted to our department between June 2003 and June 2007 were analyzed.The mean interval from CABG to index angiography was 33.8±23.5 months.Among 318 grafts,29 left internal mammary artery(LIMA,29/128,22.7%)and 117 saphenous vein bypass grafts(117/188,62.2%)were occluded.A total of 158 target lesions from these 146 vessels were treated with PCI.All target lesions were B2/C type lesion with 29.7%(47/158) chronic total occlusions.Results A total of 310 DES were implanted.The total success rate of PCI procedure Was 96.3%(130/135),and lesion success rate was 96.8%(153/158).No major clinical complications occurred during peri-intervention period.All Patients underwent PCI were followed at 12 month.Angiographie follow-up wag obtained in 89 patients and the angiographic restenosis rate Was 5.6% (5/89)in these patients.The major adverse cardiac events and target vessel revascularization rates were 5.4%(7/130)and 6.2%(8/130),respectively.Conclusion This study demonstrates that PCI procedure for graft occlusion post-CABG is feasible and safe and associated with a high procedure success rate and favorable long-term clinical and angiographic outcomes,