Meester B J, Samson M, Suryapranata H, Bonsel G, van den Brand M, de Feyter P J, Serruys P W
Thoraxcenter, Erasmus University, Rotterdam, The Netherlands.
Eur Heart J. 1991 May;12(5):648-53. doi: 10.1093/oxfordjournals.eurheartj.a059955.
Between 1981 and 1988, 107 percutaneous transluminal coronary angioplasty (PTCA) procedures, including repeat PTCA, were performed in 84 patients with previous coronary artery bypass grafting (CABG). Fifty-nine patients underwent a first angioplasty of the vein graft alone, and 25 underwent a first PTCA of the graft and one or more native vessels. Seventeen patients underwent two procedures, four patients three procedures and one patient four procedures. In 84 first angioplasties, 133 lesions were attempted; 40 lesions in native vessels and 93 graft lesions (28 ostial stenoses, 33 shaft stenoses, and 32 stenoses at the distal anastomosis). Three patients died during their hospital stay. Two patients underwent emergency CABG. Seven patients sustained an acute myocardial infarction (AMI), among whom five underwent a PTCA of an occluded vessel. The clinical primary success rate per patient was 82%. After five years, 70% of patients were alive. At a median follow-up of 2.1 years, 41% of patients were alive and event-free (no AMI, no repeat CABG, no repeat PTCA). Symptomatic improvement was maintained in 36% of patients. Angioplasty of grafts may be an alternative to re-operation in selected patients with previous bypass surgery.
1981年至1988年间，对84例曾接受冠状动脉旁路移植术（CABG）的患者进行了107次经皮腔内冠状动脉成形术（PTCA），包括重复PTCA。59例患者仅对静脉移植物进行了首次血管成形术，25例患者对移植物和一根或多根自身血管进行了首次PTCA。17例患者接受了两次手术，4例患者接受了三次手术，1例患者接受了四次手术。在84次首次血管成形术中，共尝试处理133处病变；其中自身血管病变40处，移植物病变93处（28处开口狭窄、33处血管中段狭窄和32处远端吻合口狭窄）。3例患者在住院期间死亡。2例患者接受了急诊CABG。7例患者发生急性心肌梗死（AMI），其中5例对闭塞血管进行了PTCA。患者的临床主要成功率为82%。五年后，70%的患者存活。在中位随访2.1年时，41%的患者存活且无事件发生（无AMI、无再次CABG、无再次PTCA）。36%的患者症状持续改善。对于部分曾接受旁路手术的患者，移植物血管成形术可能是再次手术的替代方案。
