Umzamo wokuqeda ukucindezeleka kwe-stent sekwephuzile
Ubuchwepheshe obusha be- stent buguqukela ekuhambeni okukhazimulayo. Ngisho nezinhliziyo ze-cardiologists zingase zibe nenkinga yokuziqondisa zonke. Nasi ukuqala okusheshayo ngezinhlobo ezintsha ze-stents ngaphansi kokuthuthukiswa, futhi kungani kudinga ama-stents aphuthumayo.
Yiziphi Izigameko Okudingeka Kuyenze?
Inhloso yonke yama-stents ukusiza ukuvimbela ukuphumula emgodini we- coronary (noma noma yisiphi isitha) ngemuva kwe- angioplasty ye- plaque atherosclerotic .
Njengoba i-angioplasty, i-catheter ibhaluni idluliselwa kuyo yonke indawo yokuvimbela umshini, futhi ibhaluni ithambekele ukuchoboza i-plaque futhi ikhulise ukuvinjelwa. I-stent yi-scaffold yensimbi esetshenziswe ngenkathi ibhaluni lithengisa ngemali elinika ukusekelwa okusezingeni eliphezulu, futhi lisiza ukugcina umshini osanda kugululwa uvuleke.
Ukuqala Kwezinguquko Zezobuchwepheshe Be-Stent
Lapho kusetshenziselwa ama-stents kuqala, baphumelela ekunciphiseni ingozi yokuphumula ngokulandela i-angioplasty ngesigamu, kusukela ku-20% ukuya ku-10% ezinyangeni ezingu-12 kulandela inqubo. (Restenosis, lapho kwenzeka, ngokuvamile kwenzeka ngonyaka.)
Ngomzamo wokunciphisa izinga lokuphumula ngisho nangaphezulu, abathuthukisi be-stent baqala ukugqoka ama-stents angenalutho ngamapulisi anezidakamizwa ezihlose ukuvimbela ukukhula kwezicubu endaweni yesiteji. Lezi zinhlamvu zibizwa ngokuthi i-drug eluting stents, noma i-DES. (I-stents yangempela, engezona izidakamizwa, ngokuphambene, yaziwa njengezinsimbi ezingenalutho, noma i-BMS.) DES zakhiwe ngokusebenzisa inqwaba yezidakamizwa, ngokuyinhloko paclitaxel, everolimus, noma i-otarolimus.
I-DES iye yaba yimpumelelo enkulu ekunciphiseni izinga lokuphumula ephakathi kuka-5 kuya ku-6% ngonyaka owodwa. Kodwa-ke, phakathi neminyaka embalwa ye-DES eba "izinga eliphakeme legolide" le-stent therapy, inkinga entsha yavela - i-thrombosis sekwephuzile.
Inkinga Ye-Thrombosis Yasekuseni
I-thrombosis enamandla iyakheka i-clot yegazi ngaphakathi komthambo endaweni yensiza.
I-thrombosis ihluke ekutheni i-restenosis, okuyinto ukubuyiswa kwezicubu. Ngokuqinisekile i-Restenosis iyinkinga, kodwa okungenani uma kwenzeka kwenzeka ukuba kancane kancane kwenzeke ukuthi ngokuvamile kunesikhathi sokuyiphatha. Ngokuphambene nalokho, ukucindezeleka okuqinile kuvele kwenzeka ngokuzumayo, ngaphandle kwesixwayiso. I-thrombosis eqinile iholela esikhathini esiphelele somthambo, futhi ngaleyo ndlela ihlose ukukhiqiza i- infarction ye-myocardial (ukushaya kwenhliziyo) noma ukufa okungazelelwe .
Inkinga ye-thrombosis yokuqala (i-clot yegazi eyenzeka ngezinsuku emva kwamasonto emva kokugaya) yaqashelwa ezinsukwini zakuqala zokugcoba, futhi yaxazululwa ngempumelelo ngokuphatha ukwelapha okunamandla okuphambene neplatelet ezinyangeni ezimbalwa ngemuva kokugubha. Ngokusetshenziswa kwe-BMS, le ndlela ibonakala iyanele.
Kodwa-ke, phakathi neminyaka embalwa yokusetshenziswa kwe-DES, inkinga ye-thrombosis esebenzayo yasheshe yafunyanwa - okungukuthi, i-thrombosis engazelelwe esiteshini se-stent eyenzeka ngonyaka noma emibili emva kwenqubo. Ukuhlukunyezwa kwe-stent esikhathini esilandelayo kuyinkinga enkulu njengengcindezi yokuqala ye-stent. Ukuze kuncishiswe ingozi, izazi ze-cardiologists manje zinikeza ukwelashwa okuphambene ne-platelet okungenani ngonyaka emva kokugulisa, futhi uma kungenzeka kakhulu isikhathi eside (mhlawumbe kuze kube phakade).
Ngenxa yokuthi ukusetshenziswa kwezidakamizwa ezinamandla eziphambene ne-platelet ngokwayo kubhekene nengozi, ukukhishwa kwe-stent thrombosis sekuye kwaholela abathuthukisi be-stent ngenhloso yokwenza uhlobo olusha lwe-stent eliqeda noma okungenani linciphise le nkinga.
I-Technologies entsha ye-Stent
Imfundiso ehamba phambili yokuthi kungani i-DES ingabangela ukuhlukunyezwa kwe-stent sekwephuzile (kuyilapho i-DES ithemba ingabangeli le nkinga) igxile ekugqokeni kwe-polymer esetshenziswa kulezi zinhlobo. Inhloso yokugqoka i-polymer ukubamba umuthi endaweni, futhi ukuyikhulula kancane kancane esikhathini esingamasonto noma izinyanga ukuze kuvimbele ukukhula komzimba kanye nokuphumula. Uma isikhulu sezidakamizwa sesikhishwe, noma kunjalo, i-polymer ayikho enye injongo.
Abacwaningi manje bakholelwa ukuthi ukugqoka i-polymer ku-DES kungase kwandise ukuvuvukala nokulibaziseka ukuphulukiswa esakhiweni sokubekwa kwe-stent, ngaleyo ndlela kwandisa ingozi ye-thrombosis enamandla.
Bathathe izindlela ezintathu zokubhekana nale nkinga, futhi izinkampani eziningana manje zakha ama-stents amasha asebenzisa zonke lezi zindlela ezintathu.
1) "Okungcono" ama-polymeri ahlala njalo. I-DES manje itholakale isebenzisa ubuchwepheshe be-polymer obubuyekeziwe. Lezi polymers ezintsha zibonakala zibangelwa ukuvuvukala okungaphansi, futhi zivumela ukuphulukiswa kwezicubu ezingcono kwisayithi yokwelapha. Kukholelwa ukuthi bancishisa kakhulu ingozi ye-thrombosis esedlule. Lezi zimpawu - ezibizwa ngokuthi "i-DES yesizukulwane sesibili" - manje zisetshenziswe kabanzi emhlabeni wonke.
2) Ama-polymers e-Bioabsorbable. I-DES (eyakhiwe futhi eyenziwe e-US) yitholakale eYurophu iminyaka eminingana eqashisa i-polymer yembatho esithatha (ilahleka) ezinyangeni ezimbalwa, ishiya isitente esingenalutho. Ngamanye amazwi, lezi zitshalo zinikeza izinzuzo ze-DES ezinyangeni ezimbalwa zokuqala (lapho kuvele khona ukuphumula), bese kuba yi-BMS, ngenengozi enciphise yokuhlushwa kwe-thrombosis. Ngo-Okthoba, 2015, i-Synergy stent (i-Boston Scientific) yaba yilapho i-polymer stent yokuqala evunyelwe yi-bioabsorbable e-US.
Ucwaningo oluthile lwenziwa ngokuqhathaniswa ne-bioabsorbable-polymer DES ne-DES nesigidi sesizukulwane sesibili. Uma kuqhathaniswa ne-DES-generation generation, ukucindezeleka kwe-stent sekwephuzile kuncishiswe nge-DES yesizukulwane sesibili kanye ne-DES bioabsorbable-polymer. Kodwa-ke, akukho lutho olubonisa ngalokhu ukuthi i-bioabsorbable-polymer DES yenza kangcono kunesizukulwane sesibili DES.
Ngaphezu kwalokho, okungenani kuze kube manje, i-DES yesizukulwane sesibili kanye ne-polymer DES entsha idinga ukwelashwa okwesikhashana ngezidakamizwa ezilwa nama-plateletlet.
3) ama-stents e-bioresorbable. Izitshalo zingaphansi kokuthuthukiswa okuphelele kakhulu - okungukuthi, yonke i-stent ibuyiswa kabusha futhi ekugcineni iyanyamalala ngokuphelele. Kukholelwa ukuthi izinzuzo ezihlinzekwa ukukhwabanisa (umphumela we-scaffold) awusadingeki izinyanga eziyisishiyagalolunye kuya kwezingu-12 emva kwenqubo - i-stent ayikho enye injongo. Ngakho kungani ungakwenzi? Izinguquko eziningana ze-bioresorbable stents zakhiwe, futhi zisemilenzeni yokusebenza emtholampilo.
Okubalulekile
Zonke ubunjiniyela obumangalisayo esizibonayo eziqhubekayo namuhla kwezobuchwepheshe obuqinile buyamangalisa, futhi kubonakala sengathi ama-stents maduzane noma kamuva azobe eseduze ukuqeda kokubili ukuphumula nokuhlushwa kwe-thrombosis. Kodwa kufanele sigcine izinto ezimbalwa ngendlela efanele.
Okokuqala, yonke le misebenzi kanye nazo zonke lezi zimali kwezobuchwepheshe obuqinile zihloswe ukubhekana nezinkinga ezimbili (restenosis kanye ne-stent thrombosis) ezibangelwa yimizamo yethu yokuphatha izifo ze-coronary artery (CAD) nge-angioplasty kanye ne-stents. Uma ngabe "asidingi" ukwenza lolu hlobo lwenqubo kuqala, lolu hlobo lomzamo omkhulu ngeke ludingekile.
Futhi okwesibini, nakuba izazi ze-cardiologists zishintsha kakhulu ukuncoma ukwelashwa okungahambi kahle kwe-CAD, kufanele sihlale sikhumbula ukuthi ama-stents akakaze aboniswe ukuthi anciphise kakhulu ingozi yokuhlaselwa yinhliziyo noma ukufa kweziguli eziningi ezine-CAD ezinzile. Ngaphambi kokuba uvumelane ne-stent, udinga ukukhuluma nodokotela wakho ukuthi ngabe i-stent izosiza yini ngempela ikusasa lakho, noma kunalokho ngabe ngabe uzongeza inkinga entsha yokuphatha engapheli kulowo onawo kakade.
Imithombo:
I-Bangalore S, I-Toklu B, i-Amoroso N, et al. Bamba izitshalo zensimbi, izidakamizwa ezinomsoco ezinomsoco ezinamandla, kanye nezidakamizwa ze-polymeric e-biolgraphic euting stents for coronary artery disease: ukuhlaziywa kwe-meta-analysis. BMJ 2013; 347: f6625.
I-Navarese EP, iTandjung K, uClaessen B, et al. Imiphumela yokuphepha nokuphumelela kwezidakamizwa eziqhamukayo eziyisizukulwane sokuqala nezizukulwane zesibili eziphakamisa ama-stents nama-polymeric biolimus eluting stents emtholampilo: ukuhlaziywa kwe-network meta-analysis. BMJ 2013; 347: f6530.
Stefanini GG, Byrne RA, Serruys PW, et al. Izindakamizwa ze-polymeric-eluting ezinamafutha angasetshenziselwa ukunciphisa ingozi yesifo sengculazi esiphezulu eminyakeni engama-4 ezigulini ezithintekayo ukungenelela kwe-coronary: ukuhlaziywa okuhlanganisiwe kwedatha ngayinye yesiguli kusuka ku-ISAR-TEST 3, ISAR-TEST 4, ne-LEADERS ukuhlolwa okungahleliwe. I-Eur Heart J 2012; 33: 1214.