Margolis J R, Mogensen L, Mehta S, Chen C Y, Krauthamer D
Cardiovascular Laboratory, South Miami Hospital, Florida 33143.
Clin Cardiol. 1991 Jun;14(6):489-93. doi: 10.1002/clc.4960140607.
Percutaneous transluminal coronary angioplasty (PTCA) was performed on 146 saphenous vein grafts in 116 patients. In 29 patients, 31 grafts were totally occluded. Myocardial staining lasting over 5 minutes--"the blush phenomenon"--followed the opening of the occluded grafts in 9 of these patients. In 5 of these 9, enzyme release suggested infarction. A sixth patient died within a few hours of PTCA, with suspected infarction. Autopsy demonstrated diffuse and extensive distal coronary arterial embolization of grumous material, including cholesterol crystals, platelets, and fibrin. The blush phenomenon was not seen following PTCA in the remaining 20 patients with total occlusions, nor in any of the 87 patients with stenosed grafts. We have not observed the blush phenomenon following PTCA of more than 3300 coronary arteries. Of the 9 patients demonstrating the blush phenomenon, 6 had a recent history of myocardial infarction or unstable angina pectoris, compared with 4 of the remaining 20 patients with occluded grafts. We now approach occluded grafts with injection of intragraft thrombolytic agents or with atherectomy prior to PTCA. Future approaches may include atherectomy or laser angioplasty.
对116例患者的146条大隐静脉移植血管进行了经皮腔内冠状动脉成形术（PTCA）。29例患者的31条移植血管完全闭塞。其中9例患者闭塞的移植血管开通后出现持续超过5分钟的心肌染色——“红晕现象”。这9例中的5例，酶释放提示梗死。第6例患者在PTCA后数小时内死亡，怀疑有梗死。尸检显示有凝块状物质的弥漫性和广泛性冠状动脉远端栓塞，包括胆固醇结晶、血小板和纤维蛋白。其余20例完全闭塞的患者在PTCA后未出现红晕现象，87例移植血管狭窄的患者也均未出现。在超过3300条冠状动脉的PTCA后，我们未观察到红晕现象。出现红晕现象的9例患者中，6例近期有心肌梗死或不稳定型心绞痛病史，而其余20例闭塞移植血管的患者中有4例有此病史。我们现在在PTCA前通过向移植血管内注射溶栓剂或旋切术来处理闭塞的移植血管。未来的方法可能包括旋切术或激光血管成形术。
