Morocutti G, Vendrametto F, Werren M, Spedicato L, Bernardi G, Gregori D, Fioretti P M
Unità Operativa di Cardiologia, Azienda Ospedaliera S. Maria della Misericordia, Fondazione IRCAB, Udine.
Ital Heart J Suppl. 2000 Jun;1(6):759-65.
Over the past two decades the use of angioplasty has rapidly expanded. As technology and experience have advanced, operators are increasingly faced with two-vessel and three-vessel disease. Coronary artery bypass graft surgery and coronary balloon angioplasty are two possible approaches for patients with multivessel coronary disease. Randomized trials comparing these two different procedures have found no difference in early as well as late mortality between assigned treatment groups. The Bypass Angioplasty Revascularization Investigation (BARI) showed a better long-term outcome with coronary artery bypass in the subgroup of patients with treated diabetes (35% died within 5 years after angioplasty compared with 19% who underwent surgery). Repeat revascularization was more common after angioplasty. Surgery offers more complete revascularization, but morbidity is higher; angioplasty is less invasive but patients are more likely to need another revascularization procedure mainly related to the occurrence of restenosis. Restenosis is often associated with the recurrence of symptoms requiring further revascularization. The use of stents and inhibitors of glycoprotein IIb/IIIa, minimally invasive surgical techniques and all-arterial grafting have the potential to change the scenery of coronary artery revascularization in the next few years.
在过去二十年中，血管成形术的应用迅速扩展。随着技术和经验的进步，手术医生越来越多地面临双支血管和三支血管病变的情况。冠状动脉旁路移植术和冠状动脉球囊血管成形术是多支冠状动脉疾病患者的两种可能治疗方法。比较这两种不同手术的随机试验发现，指定治疗组之间在早期和晚期死亡率方面没有差异。旁路血管成形术血运重建研究（BARI）显示，在接受治疗的糖尿病患者亚组中，冠状动脉旁路移植术具有更好的长期预后（血管成形术后5年内35%的患者死亡，而接受手术的患者为19%）。血管成形术后再次血运重建更为常见。手术提供更完全的血运重建，但发病率更高；血管成形术侵入性较小，但患者更有可能需要再次进行血运重建手术，主要与再狭窄的发生有关。再狭窄常与需要进一步血运重建的症状复发相关。在未来几年，支架和糖蛋白IIb/IIIa抑制剂的使用、微创外科技术以及全动脉搭桥术有可能改变冠状动脉血运重建的局面。
