Cashin W L, Sanmarco M E, Nessim S A, Blankenhorn D H
N Engl J Med. 1984 Sep 27;311(13):824-8. doi: 10.1056/NEJM198409273111304.
Accelerated progression of atherosclerosis is known to occur in surgically bypassed coronary arteries in which the preoperative stenosis was greater than 50 per cent. To assess the effect of coronary bypass on vessels with lesser degrees of stenosis, we studied 85 men who had undergone coronary bypass surgery. In this group we identified bypass grafts placed in 37 arteries with minimal atherosclerosis, which was defined as less than 50 per cent stenosis of the vessel diameter. In the same 85 men there were 93 coronary vessels with minimal atherosclerosis for which a bypass graft had not been placed. Progression of atherosclerosis, defined as further loss of at least 25 per cent of the lumen, during an average follow-up period of 37 months was more than 10 times as frequent (38 per cent vs. 3 per cent) in bypassed arteries with minimal atherosclerosis as in comparable arteries that were not bypassed. These findings support the view that minimally diseased coronary arteries should not be bypassed.
已知在术前狭窄超过50%的冠状动脉进行外科搭桥手术后，动脉粥样硬化会加速进展。为了评估冠状动脉搭桥对狭窄程度较轻血管的影响，我们研究了85例接受冠状动脉搭桥手术的男性患者。在这组患者中，我们确定了37条动脉中的搭桥移植物，这些动脉的动脉粥样硬化程度最低，定义为血管直径狭窄小于50%。在同样的85例男性患者中，有93条动脉粥样硬化程度最低的冠状动脉未进行搭桥。在平均37个月的随访期内，动脉粥样硬化进展定义为管腔至少进一步减少25%，在动脉粥样硬化程度最低的搭桥动脉中发生的频率（38%）是未搭桥的可比动脉（3%）的10倍以上。这些发现支持了不应绕过病变轻微的冠状动脉这一观点。
