Kahn J K, Rutherford B D, McConahay D R, Johnson W L, Giorgi L V, Shimshak T M, Ligon R W, Hartzler G O
Mid America Heart Institute, St. Luke's Hospital, Kansas City, Missouri.
J Am Coll Cardiol. 1994 Apr;23(5):1038-42. doi: 10.1016/0735-1097(94)90587-8.
This study was designed to evaluate the safety and short- and long-term results of coronary angioplasty of totally occluded bypass grafts in patients with clinical conditions other than acute myocardial infarction.
Total occlusion of bypass grafts after coronary artery surgery often causes recurrent ischemia. The safety and results of percutaneous transluminal coronary angioplasty in occluded bypass grafts are controversial.
All patients with dilation of a totally occluded bypass graft attempted between 1981 and 1991 were retrospectively identified from a data base. Patients treated in the setting of an acute myocardial infarction were excluded. Eighty-three patients met these criteria and constitute the study group. Hospital records, office charts and procedural reports were reviewed in all patients to supplement details available in the data base.
The time from bypass surgery to attempted coronary angioplasty ranged from 1 to 226 months (mean time 88 months). The mean (+/- SD) duration of graft occlusion was 31 +/- 46 days (range 1 to 180). In 27 attempts the bypass graft was the only site dilated, and in 56 attempts (68%) one to six other sites (n = 101) were dilated. Angiographic success (< or = 40% residual lumen stenosis) was achieved in 61 grafts (73%) and 98 of the additional sites (97%) (p < 0.001). Major complications included one procedural death and two Q wave infarctions. Follow-up for a mean of 32 months demonstrated a 1- and 3-year actuarial survival rate of 94% and 80%, respectively. At 3 years, only 34% of patients were free of repeat angioplasty or surgery.
Angioplasty of totally occluded bypass grafts can be successful in the majority of selected patients, although major complications can occur. Strategies for sustained patency are needed to improve the long-term results.
本研究旨在评估在非急性心肌梗死临床情况下，完全闭塞的旁路移植血管进行冠状动脉血管成形术的安全性及短期和长期效果。
冠状动脉搭桥术后旁路移植血管的完全闭塞常导致反复缺血。经皮腔内冠状动脉血管成形术治疗闭塞旁路移植血管的安全性和效果存在争议。
从数据库中回顾性识别出1981年至1991年间所有尝试扩张完全闭塞旁路移植血管的患者。排除在急性心肌梗死情况下接受治疗的患者。83例患者符合这些标准，构成研究组。对所有患者的医院记录、门诊病历和操作报告进行审查，以补充数据库中可用的详细信息。
从搭桥手术到尝试进行冠状动脉血管成形术的时间为1至226个月（平均时间88个月）。移植血管闭塞的平均（±标准差）持续时间为31±46天（范围1至180天）。在27次尝试中，旁路移植血管是唯一扩张的部位，在56次尝试（68%）中，一至六个其他部位（n = 101）也进行了扩张。61条移植血管（73%）和98个其他部位（97%）实现了血管造影成功（残余管腔狭窄≤40%）（p < 0.001）。主要并发症包括1例手术死亡和2例Q波梗死。平均随访32个月显示，1年和3年的精算生存率分别为94%和80%。3年时，只有34%的患者无需再次血管成形术或手术。
完全闭塞的旁路移植血管进行血管成形术在大多数选定患者中可以成功，尽管可能发生主要并发症。需要采取保持通畅的策略来改善长期效果。
