Lee Michael, Kong Jeremy
UCLA Medical Center, Los Angeles, CA, USA.
Interv Cardiol. 2017 Sep;12(2):85-91. doi: 10.15420/icr.2017:4:2.
Saphenous vein grafts (SVGs), used during coronary artery bypass graft surgery for severe coronary artery disease, are prone to degeneration and occlusion, leading to poor long-term patency compared with arterial grafts. Interventions used to treat SVG disease are susceptible to high rates of periprocedural MI and no-reflow. To minimise complications seen with these interventions, proper stents, embolic protection devices (EPDs) and pharmacological selection are crucial. Regarding stent selection, evidence has demonstrated superiority of drug-eluting stents over bare-metal stents in SVG intervention. The ACCF/AHA/SCA American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions guidelines recommend the use of EPDs during SVG intervention to decrease the risk of periprocedural MI, distal embolisation and no-reflow. The optimal pharmacological treatment for slow or no-reflow remains unclear, but various vasodilators show promise.
在严重冠状动脉疾病的冠状动脉旁路移植手术中使用的大隐静脉移植物（SVG）容易发生退变和闭塞，与动脉移植物相比，长期通畅性较差。用于治疗SVG疾病的干预措施易导致围手术期心肌梗死和无复流发生率较高。为了将这些干预措施带来的并发症降至最低，合适的支架、栓子保护装置（EPD）和药物选择至关重要。关于支架选择，有证据表明在SVG干预中，药物洗脱支架优于裸金属支架。美国心脏病学会/美国心脏协会临床实践指南工作组以及心血管造影和介入学会指南推荐在SVG干预期间使用EPD，以降低围手术期心肌梗死、远端栓塞和无复流的风险。对于慢血流或无复流的最佳药物治疗仍不明确，但各种血管扩张剂显示出前景。
