冠状动脉旁路移植术后心导管介入诊疗的研究进展

Update on Cardiac Catheterization in Patients with Prior Coronary Artery Bypass Graft Surgery

冠状动脉旁路移植术后患者后期常会因桥血管衰败而需要行心导管介入检查及再次血运重建治疗。光学相干断层成像(optical coherence tomography,OCT)可早期发现大隐静脉移植物(saphenous vein graft,SVG)内膜增生、薄纤维帽斑块及管腔内附着血栓的存在,这些均是SVG闭塞的预测因素。SVG病变介入治疗的远端栓塞及无复流发生率高,虚拟组织学成像血管内超声可用于评估SVG斑块组成,可预测无复流的发生。准分子激光冠状动脉斑块消融术及远端栓塞保护装置为降低远端栓塞及无复流的有效措施。介入治疗首选开通原位冠状动脉,但通常会很复杂,需要较高的介入治疗技术及专业的手术器械。延长双联抗血小板治疗时程及密切监测随访有助于改善患者的远期临床结局。

Patients who undergo coronary bypass graft surgery often require subsequent cardiac catheterization and repeated coronary revascularization.Optical coherence tomography(OCT)can early detect the presence of intimal hyperplasia of saphenous vein grafts,thin fibre-cap plaques and lumen attached thrombosis,which are all predictors of saphenous vein graft(SVG)occlusion.Virtual histological imaging intravascular ultrasound can be used to evaluate the composition of SVG plaques and predict the occurrence of no-reflow.Saphenous vein graft lesions have high rates of distal embolization,which can be reduced with use of Excimer laser coronary plaque ablation and distal embolization protection devices.Percutaneous coronary interventions of native coronary arteries is generally preferred over saphenous vein graft interventions,but it can often be complex,requiring expertise and specialized equipment.Prolonged dual antiplatelet therapy and close monitoring can help optimize subsequent clinical outcomes.