I-restenosis ibhekisela ekunciphiseni kabusha komzimba we-coronary artery emva kokuvinjelwa kuphathwe nge- angioplasty kanye ne- stenting . Uma i-restenosis yenzeka, ngokuvamile kwenzeka ezinyangeni ezingu-3 - 12 zenqubo. Ngoba ukuphumula kubangela ukuthi umthambo uphinde ube mncane, izimpawu ze- angina zivame ukubuya.
I-Restenosis yabonakala njengenkinga ezinsukwini zokuqala ze-angioplasty, eyenzeka kubantu abangaba ngu-40 kuya ku-50% abaphathwa nge-angioplasty yedwa.
Eqinisweni, isisekelo sokuthi ama-stents asungulwa okokuqala kwakuwukunciphisa ukukhubazeka.
Ngezinga elikhulu, ama-stents aye aphumelela ekwenzeni kanjalo. Ngisho nangesizukulwane sokuqala sezinsimbi ezingenalutho (BMS), isifo sokuphumula sanciphisa kakhulu (kuya cishe 20 - 30% ezinyangeni ezingu-12). Ngokulandelayo, ama-stuting-eluting stents (DES) asetshenziselwa ukuzama ukunciphisa ukuphumula ngisho nangaphezulu. E-DES, ama-stents agcwele izidakamizwa ezivimbela ukukhula kwezicubu eziholela ekuphumuleni.
Isizukulwane sokuqala se-DES sincishisa ukukhubazeka cishe ku-15% eminyakeni emihlanu. I-DES entsha yanciphise izinga lokuphumula ngisho nangaphezulu, cishe ku-5 kuya ku-7% eminyakeni emihlanu.
Yini Ebangela Ukuqeda Isifo?
I-Angioplasty (nokubekwa kwe-stent, njengoba ihlala njalo ihambisana ne-angioplasty) kuyindlela yokuhlukunyezwa kwezicubu. Ngesikhathi i-angioplasty, i-catheter ethwele ibhaluni ehlanjululwe idluliselwa ku- plaque ye-atherosclerotic emgodini we-coronary, bese ibhaluni ligcwala.
I-inflation ibhaluni icindezela le plaque, ngaleyo ndlela ikhulise ukuvulwa komthambo. I-stent - isistimu yezintambo ezincane - isandiswa esakhiweni se-angioplasty, ukugcina umthambo owandisiwe ukuwa phansi. Ukucindezeleka (noma "ukushaya," uma uthanda) we-plaque akuyona inqubo emnene, futhi cishe njalo kudala ukuhlukumezeka edongeni lwesitja segazi.
I-restenosis ivela ngenxa yokukhula kwezicubu endaweni yokulashwa. Kungacatshangwa ukuthi kungenxa yendlela yokuphulukisa "kulandela ukuhlukunyezwa kwendawo ye-angioplasty. Amaseli endothelial avame ukubeka umthambo we-coronary ukwanda endaweni yesehlakalo. Uma lokhu kwanda kwamangqamuzana okugcina ekudleni kugcina ngokweqile, amangqamuzana angakwazi ukuvimbela isitsha segazi endaweni yesiteji.
I-restenosis ingase ibe khona ngenxa ye-atherosclerosis ephindaphindiwe - inqubo eyabangela ukuvimbela umthambo we-coronary kuqala. I-restenosis ebangelwa ukutholakala kwesifo sofuba i-atherosclerosis ivame ukuvela isikhathi esifushane ngemva kwenqubo - unyaka noma ngaphezulu. Ukuphumula okuvamile kakhulu, okuvame ukubonakala ezinyangeni ezingu-6 futhi cishe njalo ezinyangeni ezingu-12 kulandela inqubo, kuvame ukubangelwa ukukhula komzimba kwezicubu.
Restenosis vs. Thrombosis
I-restenosis ayifani nalokhu kwesibindi esesabeka kakhulu - ukukhishwa okungazelelwe kwe-stent kusukela ekwakheni i-clot yegazi. I-thrombosis eqinile ngokuvamile iyingozi, ngoba ngokuvamile iveza ukuvinjelwa okungazelelwe nokuphelele kwe-artery coronary. Ingozi ye-thrombosis iphakeme kakhulu emasontweni ambalwa okuqala noma ezinyangeni emva kokubekwa kwe-stent, kodwa kuncishiswe kakhulu ngokusetshenziswa kwezidakamizwa zokuvimbela iplatelet .
Kukhona ingozi encane kodwa yangempela ye-thrombosis ephuzile yesikhashana - i-thrombosis eyenzeka ngonyaka noma ngaphezulu ngemuva kokufakwa kwesiteji - futhi eminyakeni yamuva sekuye kwacaca ukuthi izidakamizwa ezilwa ne-plateletlet kufanele ziqhutshwe okungenani ngonyaka owodwa futhi mhlawumbe ngisho nangaphezulu . Indlela engcono kakhulu yokuvimbela ukuhlushwa kwe-stent sekwephuzile, noma kunjalo, ihlala ingavumelani.
I-Restenosis Iphathwe Kanjani?
Ngesikhathi ukusetshenziswa kwe-DES kunciphise kakhulu ukukhubazeka kwe-stent restenosis, akuzange kuqedwe inkinga.
Uma i-restenosis yenzeka futhi ikhiqiza izimpawu ze-angina, ukwelashwa kuvame ukufaka inqubo ephindaphinda - ngokujwayelekile, ukungena kwesiteji sesibili endaweni efanayo.
Imithi yokwelashwa (engeyona engavamile) ye-angina nayo iyindlela ehlukile. I-coronary artery overpery iyindlela enye kubantu abane-stent restenosis, ikakhulukazi uma i-restenosis ibuyela ngemva kwesiteji sesibili.
Isifingqo
Ekuqaleni i-restenosis kwakuwumkhawulo omkhulu ekusebenziseni i-angioplasty ne-stents ye-coronary artery disease. Njengoba ubuchwepheshe be-stent buye buphuthumayo, ukuphumula manje sekubekelwe ubunzima kakhulu njengenkinga. Kodwa-ke, ukusebenzisa ama-stents zanamuhla kuye kwaletha enye inkinga yokuphatha ekunakekeleni i-coronary artery - stent thrombosis. Indlela engcono kakhulu yokunciphisa ingozi yale nkinga entsha isasebenza.
> Imithombo:
> Dangas GD, Claessen BE, Caixeta A, et al. I-in-stent Restenosis e-Drug-eluting Stent Era. J Am Coll Cardiol 2010; 56: 1897.
> I-Piccolo R, uStefanini GG, u-Franzone A, et al. Ukuphepha nokusebenza kwe-Resolute Zotarolimus-ehlaziya ama-Stents kuqhathaniswa nama-Everolimus-eluting Stents: ukuhlaziywa kwe-Meta. I-Circ Cardiovasc Interv 2015; 8.
> Räber L, Wohlwend L, Wigger M, et al. Imiphumela emihlanu yemitholampilo kanye ne-Angiographic imiphumela yokuqhathaniswa okungahleliwe kwe-Sirolimus-eluting ne-Paclitaxel-e-stuting Stents: Imidwebo ye-Sirolimus-Eluting Versus Paclitaxel-Eluting Stents ye-Revascularization yeConary. Ukujikeleza ngo-2011; 123: 2819.