Zimarino M, Acciai N, Cappelletti L, Vitolla G, Scarpignato M, Calafiore A M
Servizio di Emodinamica, Ospedale R. Calai, Gualdo Tadino, PG.
G Ital Cardiol. 1998 Aug;28(8):904-8.
The higher long-term patency of internal mammary artery grafts has stimulated the search for alternative conduits in order to achieve a complete arterial myocardial revascularization. Percutaneous angioplasty is often the preferred strategy for the treatment of recurrent ischemia in patients who previously underwent bypass surgery, but there is limited experience in the treatment of arterial grafts. We describe two cases of percutaneous treatment of diseased radial artery (RA) grafts. In the first case, two disarticulated stents were deployed through an RA graft: half stent inside the anastomosis to the left anterior descending (LAD) artery, and half stent in the distal LAD artery. Diffuse spasm of the RA graft, resistant to ic nitrates, was successfully reversed after ic calcium antagonists. Absence of restenosis was confirmed two years later. In the second case, after simultaneous catheterization of both the left coronary artery and RA graft, two long stents were implanted in the LAD artery and a final "reversed" kissing-balloon dilation through the stent struts was performed; four months later the patient showed proximal occlusion of the LAD artery and the stenotic RA distal anastomosis was successfully dilated.
乳内动脉移植物较高的长期通畅率促使人们寻找替代血管，以实现完全的动脉化心肌血运重建。对于既往接受过搭桥手术的患者，经皮血管成形术通常是治疗复发性缺血的首选策略，但在动脉移植物治疗方面经验有限。我们描述了两例经皮治疗病变桡动脉（RA）移植物的病例。在第一例中，通过一条RA移植物置入了两个分体式支架：一半支架置于与左前降支（LAD）动脉的吻合口内，另一半支架置于LAD动脉远端。RA移植物弥漫性痉挛，对硝酸酯类药物耐药，在给予钙拮抗剂后成功逆转。两年后证实无再狭窄。在第二例中，在同时对左冠状动脉和RA移植物进行导管插入术后，在LAD动脉植入了两个长支架，并通过支架撑条进行了最终的“反向”亲吻球囊扩张；四个月后，患者显示LAD动脉近端闭塞，狭窄的RA远端吻合口成功扩张。
