Mehta S, Margolis J R, Moore L, Pena R
Cedars Medical Center, Miami, Florida, USA.
Indian Heart J. 1995 Sep-Oct;47(5):481-4.
Recently occluded saphenous vein grafts (SVG) contain abundant thrombus. Distal embolization and myocardial infarction often occur when recanalization of such SVG is attempted. In 80 patients with occluded SVG, we employed transcatheter devices to lyse, compress or extract thrombus. Primary treatment for these SVG was performed in the following manner; PTCA 29, intragraft urokinase 12, TEC atherectomy 39. Following urokinase or atherectomy, adjunctive PTCA was performed to diminish the residual stenosis. All patients had class III or IV angina. Clinically, SVG occlusions were 3 days to 3 months old. TIMI flow was grade 0, and occlusion length was greater than 6 cm for all SVG. Each strategy resulted in a similar procedure success rate. However, when used as a primary treatment, TEC may be associated with lower rates of distal embolization and myocardial infarction.
近期闭塞的大隐静脉桥血管（SVG）内含有大量血栓。尝试对这类SVG进行再通时，常发生远端栓塞和心肌梗死。在80例闭塞性SVG患者中，我们采用经导管装置溶解、压缩或提取血栓。这些SVG的主要治疗方式如下：29例行经皮冠状动脉腔内血管成形术（PTCA），12例行血管桥内尿激酶治疗，39例行经皮腔内冠状动脉斑块旋切术（TEC）。在尿激酶治疗或斑块旋切术后，行辅助性PTCA以减轻残余狭窄。所有患者均有Ⅲ级或Ⅳ级心绞痛。临床上，SVG闭塞时间为3天至3个月。心肌梗死溶栓治疗（TIMI）血流分级为0级，所有SVG的闭塞长度均大于6 cm。每种治疗策略的手术成功率相似。然而，当作为主要治疗方法使用时，TEC可能与较低的远端栓塞和心肌梗死发生率相关。
