冠状动脉搭桥术后因乳内动脉桥再发缺血性心绞痛的治疗途径
Therapy approaches in treatment of recurrent ischemic angina with internal mammary artery bridge after coronary artery bypass grafting

摘要：目的 探讨冠状动脉搭桥术后因乳内动脉桥再发缺血性心绞痛的临床治疗方法及其疗效。方法 选取延安大学附属医院2014年1月-2016年1月收治的以乳内动脉为移植血管实施冠脉搭桥术的患者42例，所有患者术后均再次发作心绞痛，通过造影检查结果显示心绞痛系乳内动脉桥血流不足所致。根据患者的病变特征采取不同治疗方法，其中22例患者接受乳内动脉桥支架治疗(A组)；12例接受冠状动脉搭桥术(B组)；8例左锁骨下动脉近端支架(C组)。比较3组的治疗效果。结果 C组成功率最高(100%)，再狭窄率为0；A组患者住院时间显著优于B组，组间比较差异有统计学意义(P<0.05)；A组与B组患者死亡率、治疗成功率及再狭窄率比较差异无统计学意义(P>0.05)。结论 冠状动脉搭桥术后因乳内动脉桥而再发缺血性心绞痛时，应根据具体情况选择合适的治疗方法；左锁骨下动脉近段支架术具有显著疗效，患者恢复快、治疗风险小，在条件满足时可作为首选治疗方式。
ABSTRACT: Objective To investigate the clinical therapeutic methods and their curative effects in recurrent ischemic angina for internal mammary artery resterosis after coronary artery bypass grafting (CABG). Methods We enrolled the patients who had recurrence of ischemic angina for restenosis of internal mammary artery graft after CABG as research subjects in the Affiliated Hospital of Yan’an University from January 2014 to January 2016. The 42 patients were divided into three groups according to the different treatment approaches for recurrence of ischemic angina: Group A (n=22) who received internal mammary artery interventional therapy; Group B (n=12) who received coronary artery bypass grafting treatment; and Group C (n=8) who received left subclavian artery proximal stent treatment. Then we compared the clinical therapeutic effects in the three groups. Results The success rate in Group C was 100%, which was the highest in the three groups, and the post-operative restenosis rate was 0. The hospitalization time was significantly shorter in Group A than in Group B (P<0.05). However, the two groups did not significantly differ in mortality, success rate or restenosis rate (P>0.05). Conclusion We should select the appropriate treatment according to the patient’s specific situation for recurrent ischemic angina. Endovascular treatment has evident therapeutic effects, rapid postoperative recovery, and lower treatment risk, making it the preferred treatment when possible