Hong M K, Popma J J, Pichard A D, Kent K M, Satler L F, Chuang Y C, Mintz G S, Keller M B, Leon M B
Department of Internal Medicine (Cardiology Division), Washington Hospital Center, Washington, DC 20010.
Am Heart J. 1994 Jun;127(6):1496-503. doi: 10.1016/0002-8703(94)90376-x.
Standard balloon angioplasty of degenerated saphenous vein graft lesions may be complicated by distal embolization, particularly in the presence of intragraft thrombus. Transluminal extraction atherectomy may be useful in this setting because of its ability to remove particulate debris. This study was designed to identify the incidence and prognostic significance of distal embolization after transluminal extraction atherectomy in high-risk saphenous vein graft lesions. To address these issues the clinical course of 65 consecutive patients (86 high-risk saphenous vein graft lesions) was reviewed after extraction atherectomy. Distal embolization occurred in 11 (12.8%) of 86 high-risk lesions. The majority (63.6%) of these episodes occurred after adjunct balloon dilatation following uncomplicated use of the extraction atherectomy catheter. Correlates of distal embolization included patient age and the presence of intragraft thrombus. Major in-hospital complications developed more often in patients with distal embolization (46% vs 2% in those without distal embolization, p < 0.001), resulting in a reduced procedural success rate in this group (55% vs 91%, p = 0.01). We conclude that the risk of distal embolization after saphenous vein graft angioplasty, although potentially reduced, is not eliminated with transluminal extraction atherectomy, particularly in lesions with superimposed thrombus.
退化的大隐静脉移植血管病变的标准球囊血管成形术可能会并发远端栓塞，尤其是在移植物内存在血栓的情况下。腔内旋切术在这种情况下可能有用，因为它能够清除颗粒性碎片。本研究旨在确定高危大隐静脉移植血管病变腔内旋切术后远端栓塞的发生率及其预后意义。为解决这些问题，我们回顾了连续65例患者（86处高危大隐静脉移植血管病变）旋切术后的临床病程。86处高危病变中有11处（12.8%）发生了远端栓塞。这些栓塞事件大多数（63.6%）发生在无并发症使用旋切导管后进行辅助球囊扩张时。远端栓塞的相关因素包括患者年龄和移植物内血栓的存在。发生远端栓塞的患者更常出现主要的院内并发症（46% vs无远端栓塞患者的2%，p<0.001），导致该组手术成功率降低（55% vs 91%，p=0.01）。我们得出结论，大隐静脉移植血管血管成形术后远端栓塞的风险虽然可能降低，但腔内旋切术并不能消除这种风险，尤其是在合并血栓的病变中。
