Kaufmann U P, Garratt K N, Vlietstra R E, Holmes D R
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
Am J Cardiol. 1990 Jun 15;65(22):1430-3. doi: 10.1016/0002-9149(90)91349-b.
Angioplasty of stenotic saphenous vein aortocoronary bypass grafts is often unsatisfactory because of the relatively high incidence of acute complications and restenosis. During an initial evaluation of transluminal coronary atherectomy, 14 patients had atherectomy of saphenous vein graft lesions (15 grafts). Atherectomy was successful in 13 of 14 patients, decreasing the mean diameter of stenosis from 85 to 15%. In 1 patient, the lesion could not be crossed by the atherectomy device. The following 3 minor complications occurred: 1 embolus of atheromatous material; 1 air embolism; and 1 transient thrombosis leading to subendocardial myocardial infarction. Of the 14 patients, 8 underwent angiography 4 to 6 months after atherectomy; 5 patients had restenosis and 3 had widely patent grafts. Four other patients were clinically evaluated at 3 months after atherectomy. Two were asymptomatic, 1 had class II angina and 1 had class III angina. Transluminal atherectomy achieved excellent immediate results with a low incidence of major complications in the treatment of stenosed saphenous vein bypass grafts. However, preliminary follow-up results suggest a high incidence of restenosis.
由于急性并发症和再狭窄的发生率相对较高，狭窄的大隐静脉主动脉冠状动脉旁路移植血管的血管成形术往往不尽人意。在对经皮腔内冠状动脉斑块旋切术的初步评估中，14例患者接受了大隐静脉移植血管病变的斑块旋切术（15条移植血管）。14例患者中有13例手术成功，狭窄的平均直径从85%降至15%。1例患者的病变无法被斑块旋切装置穿过。发生了以下3例轻微并发症：1例动脉粥样物质栓塞；1例空气栓塞；1例导致心内膜下心肌梗死的短暂血栓形成。14例患者中，8例在斑块旋切术后4至6个月接受了血管造影；5例患者发生再狭窄，3例患者的移植血管通畅良好。另外4例患者在斑块旋切术后3个月进行了临床评估。2例无症状，1例有Ⅱ级心绞痛，1例有Ⅲ级心绞痛。经皮腔内斑块旋切术在治疗狭窄的大隐静脉旁路移植血管方面取得了优异的即刻效果，主要并发症的发生率较低。然而，初步随访结果显示再狭窄的发生率较高。
