Assulin T, Funck F, Thebault B, Bellorini M, Guillard N, Lefevre T, Loiret J, Bical O, Goudot B, Valere P
Service de cardiologie, hôpital de Pontoise.
Arch Mal Coeur Vaiss. 2000 Jun;93(6):693-701.
One hundred patients underwent early coronary angiography (average 20.5 days) after coronary bypass surgery between 1994 and 1996. The indications in clinically asymptomatic patients were: study of double mammary grafts, non respect of the preoperative plan (grafts not available, technical difficulties), and/or postoperative ECG changes. 12.1% of internal mammary grafts and 18.2% of the saphenous vein grafts were considered to be non-fractional: due to occlusion in 3 and 11.9%, due to poor implantation site (persistence of a distal stenosis): 3 and 0.8% respectively. After investigations to detect ischaemia in the region concerned or persistence of a critical lesion on a non-revascularised main artery, 26 complementary angioplasties were performed: 3 on internal mammary grafts, 4 on saphenous vein grafts and 19 on the native vessels. Surgery alone resulted in complete revascularisation in 70% and its association with cardiological interventional techniques increased the value to 85%. The association of coronary bypass surgery and transluminal angioplasty may therefore result in optimal revascularisation. This should reduce the morbidity rate, the number of hospital admissions (recurrent ischaemia and reoperation) and improve survival. However, the exact modalities of this combined revascularisation remain to be defined.
1994年至1996年间，100例患者在冠状动脉搭桥手术后接受了早期冠状动脉造影（平均20.5天）。临床无症状患者的造影指征包括：双侧乳腺移植物的研究、未遵循术前计划（移植物不可用、技术困难）和/或术后心电图变化。12.1%的乳内动脉移植物和18.2%的大隐静脉移植物被认为未充分发挥功能：分别有3%和11.9%是由于闭塞，3%和0.8%是由于植入部位不佳（远端狭窄持续存在）。在对相关区域进行缺血检测或对未行血管重建的主要动脉上的关键病变持续存在进行检查后，进行了26次补充血管成形术：3次针对乳内动脉移植物，4次针对大隐静脉移植物，19次针对自身血管。单纯手术使70%的患者实现了完全血管重建，其与心脏介入技术联合使用后，这一比例提高到了85%。因此，冠状动脉搭桥手术和经皮腔内血管成形术联合使用可能会实现最佳的血管重建。这应该会降低发病率、减少住院次数（复发性缺血和再次手术）并提高生存率。然而，这种联合血管重建的确切方式仍有待确定。
