Trono R, Sutton C, Hollman J, Suit P, Ratliff N B
Cleve Clin J Med. 1989 Sep;56(6):581-4. doi: 10.3949/ccjm.56.6.581.
Percutaneous transluminal coronary angioplasty (PTCA) of stenotic saphenous vein grafts is less invasive than repeat coronary bypass grafting; however, this procedure is complicated by atheromatous embolization in 2.5%-3.0% of cases, an incidence significantly higher than in angioplasty of native coronary vessels. We reviewed the cases of 98 patients who underwent elective saphenous vein graft angioplasty at our institution. Five patients (5.1%) had non-Q-wave myocardial infarctions after the procedure, documented by elevated serum creatine kinase. In four, atheroembolism was suspected during the procedure. Two patients died, and autopsy showed that both had multiple atherosclerotic emboli to the distal epicardial coronary artery supplied by the vein graft. In addition, multiple infarcts of varying age, some clearly antedating the angioplasty procedure, were identified. These findings suggest that both ongoing, recurrent atheroembolism as well as angioplasty-related embolism may occur in older vein grafts.
对狭窄的大隐静脉移植血管进行经皮腔内冠状动脉成形术（PTCA）的侵入性小于再次进行冠状动脉搭桥术；然而，该手术在2.5%-3.0%的病例中会并发动脉粥样硬化栓塞，这一发生率显著高于对自身冠状动脉血管进行的血管成形术。我们回顾了在我们机构接受择期大隐静脉移植血管血管成形术的98例患者的病例。5例患者（5.1%）在术后发生了非Q波心肌梗死，血清肌酸激酶升高可证明这一点。其中4例在手术过程中怀疑发生了动脉粥样硬化栓塞。2例患者死亡，尸检显示两者均有多个动脉粥样硬化栓子栓塞至由静脉移植血管供血的远端心外膜冠状动脉。此外，还发现了多个不同年龄的梗死灶，其中一些明显早于血管成形术。这些发现表明，在较旧的静脉移植血管中可能会发生持续的、复发性动脉粥样硬化栓塞以及与血管成形术相关的栓塞。
