Sigwart U
Royal Brompton National Heart and Lung Hospitals, London, UK.
Curr Opin Cardiol. 1991 Dec;6(6):918-28. doi: 10.1097/00001573-199112000-00010.
Revascularization has become an established way of treating coronary heart disease. Progression of the disease, graft failure, and surgical complications may lead to recurrent symptoms in a significant number of patients after surgical revascularization. Transluminal techniques are the preferred way of dealing with the recurrences. Saphenous vein bypass grafts present high recurrence rates when submitted to percutaneous transluminal coronary angioplasty alone; the restenosis rate of stenoses in the proximal and mid segment of bypass grafts is more than 50%. Atherectomy has become an established way of treating diseased bypass grafts if the disease is limited to short segments. The best results may currently be obtained by implantation of intraluminal stents, which not only prevent embolization of graft material but also reduce the recurrence rate. Laser techniques may find their role in treatment of diffuse native coronary artery disease, particularly in small-diameter vessels and ostial lesions.
血管重建已成为治疗冠心病的一种既定方法。疾病进展、移植物衰竭和手术并发症可能导致相当数量的患者在接受手术血管重建后出现复发症状。腔内技术是处理复发情况的首选方法。单纯经皮腔内冠状动脉成形术应用于大隐静脉旁路移植血管时复发率较高；旁路移植血管近端和中段狭窄的再狭窄率超过50%。如果病变局限于短节段，旋切术已成为治疗病变旁路移植血管的一种既定方法。目前，通过植入腔内支架可能会取得最佳效果，这不仅可以防止移植物材料栓塞，还能降低复发率。激光技术可能在弥漫性自身冠状动脉疾病的治疗中发挥作用，尤其是在小直径血管和开口病变中。
