冠状动脉旁路移植术后移植血管再狭窄及介入治疗研究

Study of grafts stenting and lesion characteristics in post-CABG patients

目的 探讨冠状动脉旁路移植 (CABG)术后移植血管病变的特征及介入治疗的效果。 方法 CABG术后的 4 3例 (男性 37例 ,女性 6例 )患者 ,因心绞痛或心力衰竭而接受冠状动脉造影复查。行多体位投照 ,发现移植血管病变特征。获得家属书面同意书后 ,行支架置入术。术后即刻进入临床随访 ,记录心脏事件发生次数 ,术后 6个月时进行冠状动脉造影。 结果 再次出现心绞痛距CABG术的时间平均为 13 7(3～ 19)个月 ,复查冠状动脉造影距旁路移植术的时间为 2 1(6～ 2 4 )个月。总计桥血管 12 1根 ,其中动脉桥 12根 (10 % ) ,静脉桥 10 9根 (90 % )。 5例 <6 0岁患者计 9根桥(1 8个桥 /例 ) ,38例≥ 6 0岁患者计 112根 (3 0个桥 /例 )。CABG术后 3例 (7 2 % )发生院内急性心肌梗死。心脏超声测得患者左心室射血分数由CABG术前 (34 6± 11 5 ) %增加到 (46 2± 10 5 ) %(P <0 0 5 )。无动脉桥体狭窄 ,1例动脉桥远端吻合口狭窄 (8 3% ) ,1例动脉桥失败后改用静脉桥。10 9根静脉桥中 ,桥病变总数 4 8根 (44 0 % ) ,其中 17根桥狭窄并血栓形成 (35 4 % ) ,31根静脉桥闭塞 (6 4 6 % ) ,闭塞位于开口后 1～ 2mm处 ,前降支和右冠状动脉的静脉桥闭塞数量 (均为 14根 ,4 5 2 % )明显多于回旋支静脉桥 (

Objective To analyze the lesion characteristics and short-term outcome of stenting for diseased grafts in post-CABG patients. Methods 43 patients with angina and/or congestive heart failure after CABG were enrolled into the present study. Stenting was performed after angiography. Angiographic follow-up was underwent and cardiac events were recorded within 6-month follow-up. Results Of 43 patients(male 37,female 6), average age was 65.3 years(38 cases≥60years),angina occurred at 13.7(3-19) months and angiogram was underwent at 21(6-20)months after CABG. Left ventricular ejection fraction was increased from (34.6±11.5)% prior-CABG to (46.2±10.5)% post-CABG( P <0.05). There were 121 grafts with 12 of arterial(10%),vein-grafts of 109(90%, P <0.05)respectively;9 vein-grafts in 5 patients(<60 years)(1.8 grafts/case),112 arterial and vein-grafts in 38 (≥60years)(3.0 grafts/case, P <0.05). 3 cases experienced in-hospital acute myocardial infarction(7.2%). 48 of 109 vein-grafts had diseases (44%),with 17 vein-grafts having thrombus(35.4%) and 31 vein-grafts occluded totally(64.6%), which were more common in grafts to LAD and RCA than grafts to LCX (14 grafts ,45.2% vs 3 grafts, 9.6%,respectively, P <0.05).3 vein-grafts had degenerated diseases. Average diseased grafts length was (23.0±7.6) mm. 35 stents were deployed in 39 lesions of 27 vein-grafts of 25 patients with average diameter, inflated pressure and length of stents being (4.1±0.9) mm,14 atm and (25.0±5.6) mm,respectively. Slow flow occurred in 4 vein-grafts and dissection in 2 calcified lesions occurred immediately after balloon inflation, which disappeared after introcoronary injection of nitroglycerin and stent implantation. 3 patients(7.5%) had re-angina within 2 months after stenting, no maj or cardiac events recorded for another 22 patients. 21 patients with 21 diseased grafts received follow-up angiogram (75%),9 grafts had restenosis ,of which target segment restenosis in 5 grafts(24%) and new lesions in 4 grafts. Conclusions Vein-grafts has worse prognosis than arterial grafts. Stenting was save and feasible for diseased grafts.