老年冠心病患者冠状动脉搭桥术后桥病变的特征及治疗Study of lesion characteristics and stenting for diseased grafts in older patients
陈绍良,叶飞,段宝祥,林松,周陵,贾海波,马玉玲
摘要(Abstract)：
目的 探讨冠状动脉搭桥术后桥病变的特征及介入治疗的效果。方法 冠状动脉搭桥术后的 38例患者 ,因心绞痛而接受冠状动脉造影复查。多体位投照并记录桥病变特征 ,获得家属书面同意后行支架术。术后即刻进入临床随访 ,随访时间为 6个月 ,记录心脏事件发生次数。患者术后6个月时再次行冠状动脉造影。结果 搭桥术后心脏射血分数由 (5 2± 10 ) %增加到 (5 8± 14 ) % (P <0 0 5 )。 38例患者中静脉桥狭窄者占 15 % ;静脉桥闭塞者占 4 0 % ,均为开口后 1～ 2mm处闭塞 ;静脉桥退行性病变者占 2 4 % ;桥内血栓栓塞为 9例 (计 11个桥 ) ,其中搭桥术后 2例发生院内急性心肌梗死患者的静脉桥均为血栓性闭塞。狭窄桥病变长度平均为 (18± 6 )mm。球囊扩张后残余狭窄 <4 0 %。术中无远端栓塞发生 ,2个静脉桥有桥内血流减慢 ,注射硝酸甘油和维拉帕米后消失 ;夹层见于 2个钙化性桥病变球囊扩张后即刻 ,均于支架置入后消失。共 2 1例患者完成 6个月的临床随访 ,1例患者支架术后 2个月时出现心绞痛 ,其余患者无心脏事件发生。 18例患者在随访 6个月时接受冠状动脉造影 ,4例患者发生支架部位再狭窄 ,靶病变部位再狭窄率为 16 6 % ,无完全闭塞。结论 静脉桥长期效果明显不如动脉桥 ,支架术安全有效。
关键词(KeyWords)： 冠状动脉搭桥术;支架术;冠状动脉疾病
基金项目(Foundation):
作者(Author): 陈绍良,叶飞,段宝祥,林松,周陵,贾海波,马玉玲
参考文献(References)：
- 1MorrisonDA .Whatconstitutesmedicallyrefractory?In:MorrisonDA ,SerruysP ,editors.MedicallyRefractoryRestAngina.NewYork,NY :MarcellDekker,1992.105118.
- 2MorrisonDA ,SethiG ,SacksJ ,etal.Percutaneouscoronaryinterventionversuscoornarybypassgraftsurgeryforpatientswithmedicalrefractorymyocardialischemiaandriskfactorsforadverseoutcomeswithbypass:Amulticenter,randomizedtrial.JACC ,2001,38:143149.
- 3HongMK ,PopmaJJ,PichardAD ,etal.Theclinicalsignificanceofdistalembolizationaftertransluminalextractionatherectomyindiffuselydiseasedsaphenousveingrafts.AmHeartJ,1994,127:12961303.
- 4DeFeyterPJ,VanSuylenRJ ,DeJaegerePPT ,etal.Balloonangioplastyforthetreatmentoflesionsinsaphenousveinbypassgrafts.JAmCollCardiol,1993,21:15391549.
- 5LoopFD ,LytleBW ,CosgroveDM ,etal.Reoperationforcoronaryatherosclerosis:changingpracticein2509consecutivepatients.AnnSurg,1990,212:378386.
- 6WongSC ,BaimDS ,SchatzRA ,etal.Immediateresultsandlateoutcomesafterstentimplantationinsaphenousveingraftlesions:themulticenterU .S .PalmatzSchatzstentexperience.JAmCollCardiol,1995,26:704712.
- 7SavageMP ,DouglasJS ,FischmanDL ,etal.Stentplacementcomparedwithballoonangioplastyforobstructedcoronarybypassgrafts.NEnglJMed,1997,223:740747.
- 8AhmedJM ,HongMK ,MehranR ,etal.Assessingastrategyofinitialstand aloneextractionatherectomyfollowedbystagedstentplacementindegeneratedsaphenoousveingraftlesions.AmJCardiol,2000,86:923926.
- 9HongMK ,MehranR ,DangasG ,etal.Arewemakingprogresswithpercutaneoussaphenousveingrafttreatment?JACC ,2001,38:150154.