Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.
Ann Thorac Surg. 2010 Apr;89(4):1146-50. doi: 10.1016/j.athoracsur.2010.01.007.
We examined the prevalence of significant proximal left subclavian artery (LSA) stenosis in patients referred for isolated coronary artery bypass grafting, and assessed management by percutaneous transluminal angioplasty (PTA) for LSA stenosis and revascularization using the left internal thoracic artery, or revascularization using grafts other than the left internal thoracic artery.
Between 1998 and 2007, significant proximal LSA stenosis was identified in 38 of 1,498 patients who underwent isolated coronary revascularization. Percutaneous transluminal angioplasty was performed before or after surgery in 20 patients (PTA group). Revascularization using grafts other than the left internal thoracic artery was performed in 18 patients with LSA stenosis unamenable to PTA (non-PTA group). Early, 1-year, and 5-year follow-up angiograms were performed to assess patency of both grafts and PTA. Computed tomographic angiography was also performed at 2 years in the PTA group.
Prevalence of significant LSA stenosis was 2.5%. Early, 1-year, and 5-year angiograms showed overall graft patency rates of 97.2% (105 of 108 distal anastomoses), 88% (81 of 92), and 92% (23 of 25), respectively. No differences were observed in graft patency rates between the two groups during the follow-up period. No intervention-related morbidities occurred in the PTA group. Estimated patency rates of PTA at 2 and 5 years were 100% and 85.7%, respectively.
Percutaneous transluminal angioplasty for LSA and revascularization using the left internal thoracic artery may be an effective treatment for patients with significant LSA stenosis. In patients with LSA stenosis unamenable to PTA, revascularization using grafts other than the left internal thoracic artery may be another treatment option.
我们研究了因孤立性冠状动脉旁路移植术而转诊的患者中近端左锁骨下动脉（LSA）显著狭窄的流行情况，并评估了经皮腔内血管成形术（PTA）治疗 LSA 狭窄和使用左内乳动脉进行血运重建的治疗方法，以及使用左内乳动脉以外的移植物进行血运重建的治疗方法。
1998 年至 2007 年间，对 1498 例接受孤立性冠状动脉血运重建的患者中，有 38 例存在显著的近端 LSA 狭窄。20 例患者（PTA 组）在手术前或手术后进行了 PTA。18 例 LSA 狭窄无法行 PTA 的患者（非 PTA 组）采用左内乳动脉以外的移植物进行血运重建。对所有移植物和 PTA 的通畅性进行早期、1 年和 5 年随访血管造影评估。在 PTA 组中，还在 2 年时进行了计算机断层血管造影。
显著 LSA 狭窄的患病率为 2.5%。早期、1 年和 5 年的血管造影显示，总体移植物通畅率分别为 97.2%（108 个远端吻合口中的 105 个）、88%（92 个中的 81 个）和 92%（25 个中的 23 个）。在随访期间，两组之间的移植物通畅率无差异。PTA 组未发生与干预相关的并发症。PTA 在 2 年和 5 年时的估计通畅率分别为 100%和 85.7%。
PTA 治疗 LSA 和使用左内乳动脉进行血运重建可能是治疗 LSA 显著狭窄患者的有效方法。对于无法行 PTA 的 LSA 狭窄患者，使用左内乳动脉以外的移植物进行血运重建可能是另一种治疗选择。
