冠状动脉桥血管吻合口病变的介入治疗及临床预后  

Clinical outcomes of percutaneous intervention for graft anastomosis lesions

作　　者：刘巍[1] 周玉杰[1] 刘宇扬[1] 吕树峥[1] 陈方[1] 李志忠[1] 

机构地区：[1]北京首都医科大学附属北京安贞医院心内科,100029

出　　处：《中国介入心脏病学杂志》2013年第2期75-79,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的本文总结桥血管吻合口病变的介入治疗特点及临床预后。方法 2005年12月至2011年12月在北京安贞医院行桥血管吻合口经皮冠状动脉介入治疗(PCI)的44例患者(47个病变)中,位于左侧内乳动脉桥远端吻合口病变9个,主动脉-静脉桥开口病变19个,静脉桥远端吻合口病变19个。临床观察终点为不良心血管事件(MACE),包括心性死亡、靶病变再次血运重建(TLR)、急性心肌梗死(AMI)。结果平均桥血管病变发生时间中位数为冠状动脉旁路移植术后5年(2个月～14年),总介入成功率为75.5%,左侧内乳动脉吻合口PCI的介入成功率为77.8%,主动脉-静脉桥开口的介入成功率为68.4%,静脉桥远端吻合口的介入成功率为78.9%。72%的病变置入药物洗脱支架(DES)。住院期间,主动脉-静脉桥开口患者3例死亡。患者平均随访中位数30个月,靶病变狭窄或闭塞(TLF)8例,占所有介入成功病例的22.8%,其中5例(14.3%)行TLR。随访30个月,累积无MACE生存率在左侧内乳动脉桥远端吻合口病变患者中为85.7%,主动脉-静脉桥开口病变为60.7%,静脉桥远端吻合口病变为94.1%。结论桥血管吻合口介入手术可行,以静脉桥主动脉开口病变的介入治疗成功率低,静脉桥远端吻合口病变置入DES的远期预后较好。Objective In this study, we sought to investigate the procedure characteristics and long term follow up of PCI for graft anastomosis lesions post CABG. Methods From Dec 2005 to Dec 2011,47 graft lesions were treated percutaneously. 9 located at proximal anastomosis, 19 located at SVG -aorto ostium, 19 located at distal anastomosis. Primary endpoint were defined as cardiac death, target lesion revascularization （TLR） ,acute myocardial infarction. Results The median graft age was 5 years old （2 month - 14 years）. PCI successful rate in LIMA anastomosis patients was 77. 8%, in SVG-aorta ostium patients was 68. 4%, in distal anastaomoiss patients was 78.9%. There were 3 procedure related death in SVG- aorta ostium group. Patients were followed up for median of 30 month, 8 cases of target lesion failure （23.8%） ,TLR rate was 14. 3%. At a median follow up of 30 months, the accumulated MACE free rate is 85.7 % in LIMA anastomosis patients and 60. 7% in SVG-aorta ostium group and 94. 1% in distal anastomosis patients. Conclusions Percutaneous treatment of osital SVG graft anastomosis had lowest procedure successful rate and distal anastomosis lesions has lowest TVR rate after DES implantation.

关 键 词：心肌桥 冠状血管 血管成形术 经腔 经皮冠状动脉 

分 类 号：R654.2[医药卫生—外科学]