准分子激光冠状动脉消蚀术治疗大隐静脉桥血管病变有效性分析

Efficacy analysis of excimer laser coronary ablation in the treatment of saphenous vein graft disease

目的评价准分子激光冠状动脉消蚀术(ELCA)在冠状动脉旁路移植术(CABG)后大隐静脉桥血管(SVG)病变经皮冠状动脉介入治疗(PCI)术中的即刻疗效。方法回顾性分析自2016年11月至2020年3月于北部战区总医院心血管内科行PCI的240例CABG术后患者的临床资料。将应用ELCA治疗的43例患者(57支SVG)纳入B组;剔除未处理SVG的37例患者,将160例未应用ELCA治疗的患者纳入A组,匹配后A组患者共43例(54支SVG)。比较两组患者的一般资料。以SVG术后TIMI血流分级和校正的TIMI血流帧数(CTFC)为主要观察终点。结果匹配后,两组患者男性比例、年龄、CABG术后时间、高血压比例、糖尿病比例、卒中史比例、充血性心力衰竭史比例、慢性肾功能不全比例比较,差异均无统计学意义(P>0.05)。B组术后TIMI 3级血流比例、CTFC<40帧比例高于A组,CTFC帧数低于A组,两组比较,差异均有统计学意义(P<0.05)。结论相比于传统PCI,在CABG后SVG病变患者的PCI术中应用ELCA可显著改善SVG的最终血流。

Objective To evaluate the immediate efficacy of excimer laser coronary ablation(ELCA)in percutaneous coronary intervention(PCI)of saphenous vein graft(SVG)disease after coronary artery bypass grafting(CABG).Methods The clinical data of 240 patients after CABG surgery who underwent PCI in the Department of Cardiology,General Hospital of Northern Theater Command from November 2016 to March 2020 were retrospectively analyzed.A total of 43 patients(57 SVG diseases)treated with ELCA were included in group B.The 37 patients who did not handle SVG were excluded,and 160 patients who did not receive ELCA treatment were included in group A.After matching,A total of 43 patients(54 SVG units)were in group A.The general data of the two groups were compared.TIMI flow grading and corrected TIMI frame count(CTFC)after SVG operation were the main observation end points.Results After matching,there were no significant differences in male proportion,age,time after CABG operation,proportion of hypertension,proportion of diabetes,proportion of stroke history,proportion of congestive heart failure history and proportion of chronic renal insufficiency between two groups(P>0.05).Postoperative TIMI grade 3 blood flow ratio and CTFC<40 frame ratio in group B were higher than those in group A,and CTFC frame number was lower than those in group A,and the differences between the two groups were statistically significant(P<0.05).Conclusion The application of ELCA during PCI in patients with SVG disease after CABG significantly improves the final flow of SVG compared to conventional PCI.