University of California-Los Angeles Medical Center, Los Angeles, California, USA.
JACC Cardiovasc Interv. 2011 Aug;4(8):831-43. doi: 10.1016/j.jcin.2011.05.014.
Saphenous vein grafts are commonly used conduits for surgical revascularization of coronary arteries but are associated with poor long-term patency rates. Percutaneous revascularization of saphenous vein grafts is associated with worse clinical outcomes including higher rates of in-stent restenosis, target vessel revascularization, myocardial infarction, and death compared with percutaneous coronary intervention of native coronary arteries. Use of embolic protection devices is a Class I indication according to the American College of Cardiology/American Heart Association guidelines to decrease the risk of distal embolization, no-reflow, and periprocedural myocardial infarction. Nonetheless, these devices are underused in clinical practice. Various pharmacological agents are available that may also reduce the risk of or mitigate the consequences of no-reflow. Covered stents do not decrease the rates of periprocedural myocardial infarction and restenosis. Most available evidence supports treatment with drug-eluting stents in this high-risk lesion subset to reduce angiographic and clinical restenosis, although large, randomized trials comparing drug-eluting stents and bare-metal stents are needed.
大隐静脉移植物通常被用作冠状动脉血运重建的手术通道，但与较差的长期通畅率相关。与经皮冠状动脉介入治疗原生冠状动脉相比，经皮大隐静脉移植物血运重建与更差的临床结局相关，包括更高的支架内再狭窄、靶血管血运重建、心肌梗死和死亡发生率。根据美国心脏病学会/美国心脏协会指南，使用栓塞保护装置是减少远端栓塞、无复流和围手术期心肌梗死风险的 I 类适应证。尽管如此，这些装置在临床实践中并未得到充分应用。有多种药理学药物可用于降低无复流的风险或减轻其后果。覆膜支架并不能降低围手术期心肌梗死和再狭窄的发生率。大多数现有证据支持在这种高危病变亚组中使用药物洗脱支架来减少血管造影和临床再狭窄，尽管需要进行比较药物洗脱支架和金属裸支架的大型随机试验。
