Emashumini ambalwa ambalwa adlule, ama-stents ashintshe ukwelashwa kwesifo se- coronary artery . Ama-stents ayizinsimbi zensimbi zensimbi zensimbi ezenziwe zibe umshini wokuthi "zivuleke" umthambo ngemuva kwe- angioplasty . Cishe zonke izinqubo ze-angioplasty namuhla zifaka ukungena kwe-stent.
Inhloso Yezintambo
Izitshalo zenzelwe ukunciphisa inkinga yokuphumula , okwenzeka njalo ngemuva kwe-angioplasty yedwa.
I-restenosis ibangelwa ukukhula kwamathambo amasha endaweni ye-angioplasty, mhlawumbe ecasulwe yi-trauma okuyinto i-angioplasty eqhubeka nayo lapho iphoqa i- plaque atherosclerotic .
Izitshalo zokuqala zenziwe ngensimbi engakhiwe (metal metal stents, noma i-BMS). Izitshalo eziningi zanamuhla zigcwele izidakamizwa ezivimbela ukukhula kwezicubu, futhi ngaleyo ndlela zivimbela ukuphumula. Lezi zibizwa ngokuthi yi-drug eluting stents, noma i-DES. Izitshalo - ikakhulukazi i-DES - ziye zanciphisa kakhulu inkinga yokuphumula.
I-Stents ifakiwe kanjani?
Ama-stents afakwa ngokubeka i-stent ehlekile phezu kwe-balloon ehlanjululwe ekupheleni komgodla. I-catheter iqhubekela phambili engxenyeni ye-artery esanda kutholakala nge-angioplasty, futhi ibhaluni iyancipha, ngaleyo ndlela yandisa i-stent ngokumelene nodonga lwe-artery. Ibhaluni ibuye ihlanjululwe futhi i-catheter isuswe, ishiye isiteji endaweni. Ngokuvamile, ibhaluni lentengo elisetshenziselwa ukwandisa i-stent nayo isetshenziselwa ukwenza i-angioplasty yangempela, ukuze i-angioplasty / stenting yenziwe ngesinyathelo esisodwa.
Izitshalo zivela ngobukhulu obukhulu nobubunjwa ukuze kuvunyelwe i-cardiologist ukuba ikhethe idivayisi eyofanela kahle umthambo wesiguli.
Izinkinga Ngezintambo
Izinkinga zingase zenzeke uma i-stent ihlelwe ngendlela engafanele ngaphakathi komshini, noma uma isisindo samasayizi angalungile noma isimo sisetshenziswa. Uma i-stent ifakwe emthini awukwazi ukususwa, ngakho-ke izinkinga ezihlobene "nokuthunyelwa okuncane" okunzima ukuphatha, futhi zingadinga ukuhlinzwa ngokudlula .
Lezi zinkinga zazivama kakhulu ezinsukwini zokuqala zokusetshenziswa kwe-stent, lapho kunezinhlobo ezimbalwa zezintambo ezitholakalayo ezizokhethwa kuzo. Ngenhlanhla, ingozi yezinkinga kusuka ekuthunjweni okungekho emthethweni ingaphansi kwe-1% namuhla.
Ukucindezeleka okubaluleke kakhulu okubonwa nge-stents yi-thrombosis enamandla.
I-stent Thrombosis
Ngenkathi ama-stents ephumelele ekunciphiseni inkinga enkulu ehlotshaniswa ne-angioplasty - restenosis - baye bafaka inkinga entsha - ukuhlushwa kwe-stent. I-thrombosis eqinile ukukhishwa ngokungazelelwe kwe-artery coronary esakhiweni sokubekwa kwe-stent, okubangelwa ukwakheka okungazelelwe kwe-clot yegazi. Lesi senzakalo esiphuthumayo ngokuvamile siyingozi, okuholela ekutheni i-myocardial infarction (ukushaya kwenhliziyo) noma ukufa. Ngenhlanhla, isifo se-stent thrombosis sincane kakhulu - uma nje izidakamizwa zama-plateletlet zisetshenziselwa ukuvimbela ukugaya igazi.
- Funda kabanzi mayelana nokucindezeleka kwe-stent.
Zonke iziguli ezithola ama-stents zidinga ukuba zibekwe "emithini yama-double anti-platelet" (DAPT) amabili nezidakamizwa ezimbili eziphambene neplatele ukuze zivimbele ukuvinjwa kwegazi: i- aspirin , kanye ne-block2 ye-receptor blockers. Ama-blockers e-P2Y12 asetshenziselwa ukuvimbela ukucindezeleka kwe-stent yi-clopidogrel (i- Plavix ), i-prasugrel (Umfutho), ne-ticagrelor (i-Brilinta).
I-DAPT ithatha izingozi zayo, futhi kukhona impikiswano eningi mayelana nokuthi iziguli kufanele zihlale kanjani kulezi zidakamizwa ngemuva kokuthola i-stent. Ngenxa yokuthi kungenzeka ukuthi isifo se-stent sekwephuzile (okungukuthi, i-thrombosis eyenzeka ngonyaka noma ngaphezulu ngemuva kokubekwa kwe-stent), ezinye iziphathimandla ziyanxusa odokotela ukuba bagcine iziguli zabo eziqinile kwi-DAPT okungenani iminyaka eminingana, noma mhlawumbe kuze kube phakade.
Okubalulekile
Okubalulekile ukuthi lezi zitshalo zanciphisa kakhulu ingozi yokuphumula, futhi zenze ukwelashwa (okungenani) okungenakuvuthwa kwe-coronary artery blockages okwenziwe futhi okujwayelekile.
Kodwa-ke, ukwamukela i-stent njalo kuveza inkinga entsha-ingozi yokucindezeleka okunamandla - futhi ukulawula kahle le ngozi akuyona inkinga encane.
Noma ubani udokotela ogunyaza i-stent udinga ukucabangela ngokucophelela kokubili izingozi nezinzuzo zalolu cwaningo, kanye nazo zonke ezinye izindlela zokwelapha ezitholakala ezifo zesifo se-coronary.
- Funda mayelana nenkinga ngama-stents.
- Ingabe ama-stents awusizo ngempela ekwelapheni ama-angina azinzile?
- Funda mayelana nakho konke ukwelashwa kwesifo somzimba we-coronary.
Imithombo:
Fischman, DL, Leon, MB, Baim, DS, et al. Ukuqhathaniswa okungahleliwe kokubekwa kwe-coronary- stent ne-balloon angioplasty ekwelapheni isifo se-coronary artery. N Engl J Med 1994; 331: 496.
Colombo, A, Stankovic, G, Moses, JW. Ukukhethwa kwama-coronary stents. J Am Coll Cardiol 2002; 40: 1021.
Mauri L, Kereiakes DJ, Yeh RW, et al. Ezinyangeni eziyishumi nambili noma ezingu-30 zomuthi we-antiplatelet owodwa ngemuva kokusebenzisa izidakamizwa-e-stuting. N Engl J Med 2014; I-DOI: 10.1056NEJMoa1409312.
I-Columbo A ne-Chieffo A. Ukwelashwa kwe-antiplatelet ka-Dual ngemuva kokudakwa kwezidakamizwa-eziphuthumayo-Kuzoze kube nini ukuphatha? N Engl J Med 2014; I-DOI: 10.1056 / NEJMe1413297.