冠状动脉旁路移植术后再发心绞痛的介入治疗分析

目的分析冠状动脉（冠脉）旁路移植术（CABG）后再发心绞痛的原因及进行介入治疗的有效性和安全性。方法再发缺血症状的CABG术后老年患者78例，进行冠脉和桥血管造影，并同时对53例进行介入治疗。结果78例均进行冠脉和桥血管造影，其中8例桥血管通畅，原冠脉病变无或有轻微发展；17例桥血管严重狭窄或全部闭塞，同时，原冠脉3支弥漫严重病变；53例原冠脉血管病变有明显进展或桥血管出现严重病变或闭塞。78例共移植桥血管226支（其中大隐静脉桥血管153支，乳内动脉桥69支，桡动脉桥4支）。大隐静脉桥血管153支中，110支发生病变（71．9％，其中长段弥漫性病变或完全闭塞77支，吻合口狭窄14支，体部狭窄19支）。乳内动脉桥共69支，27支发生病变，占39．1％（其中全程弥漫性病变和完全闭塞12支，吻合口狭窄15支）。桡动脉桥共4支，通畅3支，吻合口狭窄1支。226支桥血管发生病变共有138支（包括大隐静脉桥血管110支，乳内动脉桥27支，桡动脉桥1支），桥血管吻合口狭窄30支，体部病变19支，弥漫病变或完全闭塞89支。在吻合口狭窄的桥血管中，术后0～3个月发生21支（70.0％），术后3～12个月发生9支（30．0％），术后1年以上无吻合口狭窄。在体部病变的桥血管中术后0～3个月未发生病变，术后3～12个月发生10支（52．6％），术后1年以上发生9支（47．7％）。桥血管弥漫病变或完全闭塞术后0～3个月发生28支（31．5％），术后3～12个月发生14支（15．7％），术后1年以上发生47支（52．8％）。53例患者进行原发血管和（或）桥血管介入治疗，50例介入治疗成功（94、3％）。所有病变介入治疗后均即刻获得良好结果，30d随访，未出现严重心脏事件。结论CABG术后再发心绞痛介入治疗成功率、有效性、安全性均较高，介入治疗可作为CABG术后再发缺血的主要治疗手段之一。

Analysis of interventional therapy for recurrence of angina pectoris after coronary artery bypass graft surgery

Objective To analyze the cause of angina recurrence after coronary artery bypass graft (CABG),the effectiveness and security of the interventional therapy.Methods Seventy-eight patients had clinical ischemia symptoms after CABG and underwent coronary artery and bridge vessel angiography.Among them,53 patients received further interventional therapy.Results Among the 78 cases,8 patients showed no bridged vessels obstruction,and no or little pathological developnent in coronary arteries.Seventeen cases had severe stenosis or total obstruction in bridged vessels,with multi-stenosis of originally diseased coronary artery.Fifty-three cases had obvious advancement in coronary artery lesion,and severe stenosis or total obstruction of bridged vessel.Seventy-eight patients had 226 bridged vessels,including 153 great saphenous veins,69 internal mammary arteries, 4 radial arteries.There were 110(71.9%) great saphenous vein lesions,including 77 diffuse lesion or total obstruction,14 stoma stenosis,19 caudomediai part stenosis.Among 69 internal mammary artery bridge,there were 27 (39.1%)bridged vessel lesions,including 12 diffuse lesion or obstruction,15 stoma stenosis.There were 4 radial artery bridged vessels:3 without obstruction,1 with stoma stenosis.There were 138 vessel lesions in 226 bridged vessels,including 110 great saphenous veins, 27 internal mammary arteries,1 radial arteries.The 138 bridged vessel lessions included 30 stoma stenosis,19 caudomedial part stenosis,89 diffuse lesion or obstruction.There were 21 (70.0%) stoma stenosis emerging after 0-3 months,9 (30.0%) stoma stenosis after 3-12 months.There were 10(52.6%) caudomedial part stenosis emerging after 3-12 months,9 (47.4%)caudomedial part stenosis after 1 year.There were 28 (31.5%)diffuse lesions or obstruction of bridged vessels occurring after 0-3 months,14 (15.7%)diffuse lesions or obstruction after 3-12 months,47 (52.8%) diffuse lesions or obstruction after 1 year.Further interventional therapy were held in 53 patients,and 50 (94.3%)operations succeeded.All interventional therapy had immediately fine therapeutic effect. There were no patients having severe cardiac events within 30 days.Conclusions Interventional therapy is effective and reliable,and will be one of the principal therapeutic tools for clinical isehemia symptom after CABG.