Isshiki T, Yamaguchi T, Tamura T, Saeki F, Furuta Y, Ikari Y, Chiku N, Suma H
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
J Am Coll Cardiol. 1993 Sep;22(3):727-32. doi: 10.1016/0735-1097(93)90183-2.
This report describes our early experience and results with percutaneous transluminal coronary angioplasty of gastroepiploic artery grafts in 12 patients.
Angioplasty has been successfully performed in saphenous vein and internal thoracic artery grafts; however, experience with angioplasty in gastroepiploic artery/coronary artery bypass grafts is limited.
Balloon angioplasty was performed in 12 patients (11 men, 1 woman; mean age 58 +/- 8 years) with either total occlusion (6 patients) or severe stenosis (6 patients) of a gastroepiploic artery/coronary artery anastomosis. In seven patients, a guide wire/balloon catheter system was used through a 7F sheath inserted into the celiac trunk. In seven patients, including two who had unsuccessful wire/balloon angioplasty, an over the wire system was used through a 6.5F Cobra or 7F JR4 guide catheter, selectively inserted into the gastroduodenal artery.
Angioplasty was successful in five (83%) of six patients with stenosis and in one of six patients with total occlusion (p = 0.08, 1 - beta = 0.68). The guide wire could not be advanced through the lesion in five patients, and the balloon catheter did not cross the lesion in one patient whose gastroepiploic artery was tortuous. Catheters exhibited better trackability and pushability when the over the wire system was used, and five of the six successes were achieved using this approach. Follow-up arteriography was performed in five patients, and all of the gastroepiploic artery grafts were patent without stenosis.
Angioplasty can be safely performed in stenosed gastroepiploic artery grafts. An over the wire system that uses a thin balloon catheter inserted through a guide catheter in the gastroduodenal artery seems optimal.
本报告描述了我们对12例患者行胃网膜动脉移植血管经皮腔内冠状动脉成形术的早期经验和结果。
血管成形术已成功应用于大隐静脉和胸廓内动脉移植血管；然而，胃网膜动脉/冠状动脉旁路移植血管的血管成形术经验有限。
对12例患者（11例男性，1例女性；平均年龄58±8岁）进行球囊血管成形术，这些患者的胃网膜动脉/冠状动脉吻合口存在完全闭塞（6例）或严重狭窄（6例）。7例患者通过插入腹腔干的7F鞘管使用导丝/球囊导管系统。7例患者，包括2例导丝/球囊血管成形术失败的患者，通过6.5F眼镜蛇或7F JR4引导导管使用导丝系统，选择性插入胃十二指肠动脉。
6例狭窄患者中有5例（83%）血管成形术成功，6例完全闭塞患者中有1例成功（p = 0.08，1-β = 0.68）。5例患者导丝无法通过病变部位，1例胃网膜动脉迂曲的患者球囊导管无法穿过病变部位。使用导丝系统时导管显示出更好的跟踪性和推送性，6例成功中有5例是使用这种方法实现的。5例患者进行了随访血管造影，所有胃网膜动脉移植血管均通畅无狭窄。
血管成形术可安全地应用于狭窄的胃网膜动脉移植血管。通过插入胃十二指肠动脉引导导管的细球囊导管使用导丝系统似乎是最佳方法。
