Kahn J K, Rutherford B D, McConahay D R, Giorgi L V, Johnson W L, Shimshak T M, Hartzler G O
Cardiovascular Consultants, Inc., Kansas City, Missouri 64111.
Am J Cardiol. 1990 Oct 15;66(12):943-6. doi: 10.1016/0002-9149(90)90930-y.
In a small number of patients, coronary artery bypass grafting (CABG) fails to relieve anginal symptoms. The usefulness of coronary angioplasty for the treatment of early (less than or equal to 90 days) recurrent ischemia after CABG was examined. Forty-five patients were treated from 2 to 90 days after CABG, including 8 patients studied emergently for prolonged ischemic symptoms. One-, 2- and 3-vessel native disease was found in 4, 10 and 31 patients, respectively. At the time of postoperative angiography, the major anatomic mechanism of recurrent ischemia was complete vein graft occlusion in 12 patients (27%), internal mammary artery occlusion in 3 (7%), vein graft stenoses in 13 (29%), internal mammary artery stenoses in 10 (22%), unbypassed disease in 4 (8%) and disease distal to the graft insertion site in 3 (7%). Angioplasty was successful at 91 of 98 sites (93%), including 95% of 41 lesions in native arteries, 89% of 46 lesions in vein grafts and 100% of 11 internal mammary artery lesions attempted. Complete revascularization was achieved in 84% of patients. There were 2 in-hospital deaths and 2 myocardial infarctions. Two additional patients underwent repeat CABG before discharge after uncomplicated but unsuccessful angioplasty. At late follow-up of the 43 survivors (mean 44 months), there were 4 deaths, 2 of which were noncardiac. Repeat CABG was required in only 3 patients and repeat angioplasty was performed in 10. Angina was absent or minimal in 35 patients; 17 patients were employed full time. Thus, percutaneous transluminal coronary angioplasty can relieve myocardial ischemia after unsuccessful CABG in the majority of patients.
在少数患者中，冠状动脉旁路移植术（CABG）未能缓解心绞痛症状。本研究探讨了冠状动脉血管成形术治疗CABG后早期（小于或等于90天）复发性心肌缺血的有效性。45例患者在CABG术后2至90天接受治疗，其中8例因持续性缺血症状而接受急诊检查。分别有4例、10例和31例患者存在单支、双支和三支冠状动脉病变。术后血管造影时，复发性心肌缺血的主要解剖学机制为：12例（27%）患者静脉桥完全闭塞，3例（7%）患者乳内动脉闭塞，13例（29%）患者静脉桥狭窄，10例（22%）患者乳内动脉狭窄，4例（8%）患者未搭桥病变，3例（7%）患者移植血管吻合口远端病变。血管成形术在98个部位中的91个成功（93%），包括95%的41处冠状动脉病变、89%的46处静脉桥病变和100%的11处乳内动脉病变。84%的患者实现了完全血运重建。有2例住院死亡和2例心肌梗死。另外2例患者在血管成形术未成功但无并发症后出院前接受了再次CABG。在43例幸存者的后期随访（平均44个月）中，有4例死亡，其中2例为非心脏原因。仅3例患者需要再次CABG，10例患者接受了再次血管成形术。35例患者心绞痛消失或轻微；17例患者全职工作。因此，经皮冠状动脉腔内血管成形术可在大多数CABG失败的患者中缓解心肌缺血。
