Hayase S, Yano Y, Ogawa K, Fujita K, Yuasa T, Shirota K, Kidokoro H, Hattori T
Department of Thoracic Surgery, Japanese Red Cross, Nagoya First Hospital.
Kyobu Geka. 1994 Jul;47(8):622-7.
PTCA or reCABG was performed for ischemic events after CABG in 32 patients. Since 6 patients were operated on initially elsewhere, the incidence of reCABG among our own patients was 1.2% and that of PTCA was 4.5%. Only one patient of 15 patients, in whom internal thoracic artery (ITA) was utilized at the initial CABG, underwent reCABG and the other patients were treated by PTCA. The use of ITA reduced the necessity for re-CABG because of the superior long-term patency of ITA. PTCA was performed for 32 lesions (19 in saphenous vein grafts (SVG), 4 in ITA grafts, and 9 in native coronary arteries) of 23 patients with success rate of 88%. The rate of restenosis was 36%. There were no complications following PTCA. No patients were referred for emergent surgery. Intracoronary thrombolysis and PTCA for total occlusion of SVG were performed successfully if they were done early after the occurrence of ischemic events. Coronary angiography should be performed as soon as possible. Ten patients underwent re-CABG utilizing ITA in 9 patients and gastro-epiploic artery (GEA) in 3. One patient died of arrhythmia due to spasm. The other 9 patients were discharged and class I or II of NYHA functional classification. The coronary angiography, which was performed at the late follow-up period, showed occlusion of SVG and patency of ITA. The arterial conduits should be applied for reCABG because of the low long-term patency of SVG.
32例患者在冠状动脉旁路移植术（CABG）后因缺血事件接受了经皮冠状动脉腔内血管成形术（PTCA）或再次CABG。由于6例患者最初在其他地方接受手术，我们自己患者中再次CABG的发生率为1.2%，PTCA的发生率为4.5%。在最初CABG时使用了胸廓内动脉（ITA）的15例患者中，只有1例接受了再次CABG，其他患者接受了PTCA治疗。由于ITA具有更好的长期通畅性，使用ITA减少了再次CABG的必要性。23例患者的32处病变（19处位于大隐静脉桥血管（SVG）、4处位于ITA桥血管、9处位于自身冠状动脉）接受了PTCA，成功率为88%。再狭窄率为36%。PTCA后无并发症发生。无患者被转诊进行急诊手术。如果在缺血事件发生后早期进行，冠状动脉内溶栓和PTCA治疗SVG完全闭塞均取得成功。应尽快进行冠状动脉造影。10例患者接受了再次CABG，其中9例使用ITA，3例使用胃网膜动脉（GEA）。1例患者因痉挛死于心律失常。其他9例患者出院时纽约心脏协会（NYHA）功能分级为I级或II级。在后期随访时进行的冠状动脉造影显示SVG闭塞，ITA通畅。由于SVG长期通畅率低，动脉移植物应应用于再次CABG。
