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目的:分析总结冠状动脉搭桥术(CABG)术后症状复发患者的冠状动脉造影(CAG)特点,探讨心肌缺血原因及其治疗对策。方法:对74例CABG术后心肌缺血复发患者行冠状动脉造影及桥血管造影,总结其自体冠状动脉和移植血管病变特点,分阶段归纳心肌缺血的可能原因。结果:74例患者中男性72例,女性2例,平均年龄(63.3±9.3)岁,平均复查时间(37.79±37.65)个月。共174支移植血管,其中左乳内动脉桥44支,大隐静脉桥126支,桡动脉桥4支。左乳内动脉桥完全闭塞20.5%(9/44),狭窄18.2%(8/44);静脉桥闭塞40.5%(51/126),狭窄7.1%(9/126);4例桡动脉搭桥,2例有狭窄;竞争血流现象的发生率为12.2%(9/74);32.5%(24/74)的患者自体冠状动脉病变加重;13.5%(10/74)的患者存在再血管化不完全;CABG术后早期(1个月以内)心肌缺血的主要原因是左乳内动脉桥吻合口狭窄(占50%),1年以内主要与静脉桥血管狭窄和闭塞有关(占44.7%),而1年和5年以后则绝大多数缘于静脉桥的闭塞(占46.7%)。45.8%(34/74)的患者行药物保守治疗,9.5%(7/74)的患者行再次外科搭桥(reCABG),29.7%(22/74)接受了自体血管的介入治疗(PCI),12.2%(9/74) 行桥血管的介入治疗。移植血管的介入治疗成功率接近90%,自体血管的介入治疗成功率72.2%。结论:CABG后部分患者心肌缺血可以复发,其中移植血管病变是引起心肌缺血的主要原因,其它原因有再血管化不完全、自体血管病变加重等,自体血管和狭窄桥血管的介入治疗对CABG后心肌缺血复发患者具有较高的成功率和较低的并发症发生率,因此仍然是可取的治疗方法。
Objective: To analyze the characteristics of coronary artery angiography (CAG) in patients with recurrence of coronary artery bypass graft (CABG) and to investigate the causes and treatment of myocardial ischemia. Methods: Totally 74 patients with myocardial ischemia recurrence after CABG underwent coronary angiography and bridge angiography. The characteristics of autologous coronary artery and graft vessel were summarized. The possible causes of myocardial ischemia were summarized in different stages. Results: Among the 74 patients, there were 72 males and 2 females, with an average age of 63.3 ± 9.3 years and an average of 37.79 ± 37.65 months. A total of 174 grafts, of which 44 were left internal mammary artery artery bridge, 126 saphenous vein and 4 radial artery bridge. The left internal mammary artery occlusion was completely occluded by 20.5% (9/44) and narrowed by 18.2% (8/44). The occlusion of venous bridge was 40.5% (51/126) and stenosis was 7.1% (9/126) 2 cases had stenosis; the rate of competitive blood flow was 12.2% (9/74); 32.5% (24/74) patients had increased autologous coronary artery disease; and 13.5% (10/74) had revascularization The main reason of myocardial ischemia in CABG early (within 1 month) was the narrow anastomotic stenosis (50%) in the left internal mammary artery, and the main reason was the stenosis and occlusion of the IVF within 1 year (44.7%). , While most of them were occluded by venous bridges after 1 year and 5 years (46.7%). 45.8% (34/74) received conservative drug treatment, 9.5% (7/74) received reCABG, 29.7% (22/74) received autologous vascular intervention (PCI), 12.2 % (9/74) interventional treatment of vascular bridge. The success rate of interventional grafting was nearly 90% and the success rate of autologous vascular intervention was 72.2%. Conclusions: Myocardial ischemia can recur in some patients after CABG. The main cause of myocardial ischemia is graft disease. Other causes include incomplete revascularization, increased autologous vascular disease, interventional therapy of autologous blood vessels and narrowing blood vessels Patients with recurrent myocardial ischemia after CABG have a higher rate of success and a lower incidence of complications and are therefore still desirable treatments.