Izinketho zezokwelapha nezokuhlinzekela nge-Carotid Artery yakho
Imishanguzo ye-carotid yimizila emibili yegazi egijima ezinhlangothini zentamo yakho engena ebuchosheni bakho. Kanye nemithambo emibili ye-vertebral ngemuva kwentamo, i-carotids ivumela indlela yokuba ubuchopho bamukele igazi elidinga oksijini.
Sibutsetelo
Njenganoma yimuphi omunye umthambo, i-carotids ingonakaliswa. Umfutho wegazi ophakeme, i-cholesterol ephakeme, nokubhema kuyizindlela ezimbalwa zokukhuphula ingozi ye- plaque buildup ku-carotids nakweminye imithwalo yegazi.
Uma i-plaque ikhiqiza esitsheni senhliziyo, ingabangela ukuhlaselwa kwenhliziyo . Lapho i-plaque ikhiqiza esitsheni segazi noma isendaweni yobuchopho, ingabangela isifo .
I-carotid stenosis iyigama elisetshenziselwa ukukhombisa umthambo we-carotid omncane. Uma i-plaque igcizelela umshini we-carotid, ingabangela ukushaywa ngezindlela ezimbili. Indlela evamile kakhulu ingxenye ye-plaque ukuze ihlukane, ifake i- embolus , futhi ihambe ngemithambo yegazi kuze kube yilapho ifaka khona futhi ivimba ukugeleza kwegazi ibe yingxenye yobuchopho. Lezi zicubu zifa ngenxa yokuntuleka kwe-oxygen - lokhu kubizwa ngokuthi i- ischemia .
I-Carotid stenosis inganciphisa ukugeleza kwegazi ebuchosheni ukuze uma ukucindezeleka kwegazi kwehla, ingxenye yengqondo kuye ngokuthi lowo mshini awutholi igazi elanele. Lesi simo asivamile kakhulu kune-embolization ngoba ubuchopho bakhelwe ukuhlinzeka ngezicubu kusuka emthini ongaphezu kweyodwa ngesikhathi, njengendlela yokuqapha ngokulimala kwe-ischemic.
Ukwelapha
Ngenxa yokuthi i-carotid stenosis iyingozi kakhulu yokushaywa yisifo, ngeke ilandelwe. Kodwa-ke, kunengxabano ethile mayelana nendlela i-carotid stenosis ephathwa ngayo kangcono. Kunezindlela ezintathu eziyinhloko zokwelapha i-carotid stenosis:
- ukwelashwa
- ukwelapha ukwelashwa (carotid endarterectomy)
- ukuthukuthela okuncane okungavamile kwamasongo .
Ukwelashwa
Kuze kube seqophelweni, ukwelashwa kwe-carotid stenosis kubhekwa wonke umhlaba ukuthi kuyindlela engcono kakhulu. Isibonelo, uma umthambo we-carotid ungaphansi kwe-50% encane, ngokuvamile akudingeki ukwelashwa okungahambi.
Esikhundleni salokho, ukwelashwa kugxile ekuqinisekiseni ukuthi i-plaque ayitholi enkulu. Izici ezinobungozi ezifana nokubhema, umfutho wegazi ophakeme kanye ne- cholesterol ephakeme kudingeka zibhekiswe. Njengokuvamile, ukudla nokuzivocavoca kuyaqhubeka kubaluleke kakhulu.
Ngaphezu kwalokho, udokotela uzovame ukubeka uhlobo oluthile lwegazi elincane ukuze kuvinjelwe i-clot ekwakheni nokuvimbela umthambo noma ukuya ebuchosheni. Ngokuya ngobukhulu becala, lokhu kungahle kube nokunye okulula njenge-aspirin kunento efana no-Coumadin.
Ochwepheshe abaningi bayavuma ukuthi ukwelashwa okungcono kakhulu kwezokwelapha kuye kwaqhubeka ukuthuthukisa ngokuhamba kwesikhathi, okwenza kube inketho enamandla nakakhulu uma kuqhathaniswa nezinqubo eziningi ezingenayo.
Ukwelapha Okuhlinzekwayo
I-Carotid endarterectomy (CEA) yindlela yokuhlinzwa lapho i-carotid ivuleka khona futhi i-plaque ihlanzwa. I-carotid endarterectomy iye yafundwa kahle, futhi idatha ibonisa ukuthi ithuthukisa imiphumela ngokugcwele ngaphansi kwezimo ezikhethiwe. Lezi zimo zihlanganisa okulandelayo:
- I-carotid kumele ivinjelwe kakhulu (ngokuvamile engaphezu kuka-60%) kodwa ingavinjelwe ngokuphelele.
- Udokotela ohlinzayo kumele abe nekhono, ngesilinganiso esincane kakhulu sokufa esihlotshaniswa nokuhlinzwa.
- Isiguli kumele sibe nenempilo enye ngokwanele ukuze siphulule kahle enkambweni yokuhlinzwa.
Imiphumela emibi engenzeka ye-CEA ibandakanya ingozi ye-3 kuya ku-6 yamaphesenti okushaya noma ukufa. Okungenani ngenyanga emva kwenqubo, ingozi yokuhlasela kwenhliziyo ibonakala inkulu kulabo ababhekene ne-CEA kune-carotid stenting (bheka ngezansi). Futhi, ngenxa yokuthi izinzwa ezithile zomzimba zithola igazi lawo kulo mkhumbi, zingalimala ngesikhathi sokuhlinzwa. Ngaphezu kwalokho, ukuvula i-carotid kungabangela ukulimala kwe-hyperperfusion , okungukuthi ubuchopho abukwazi ukulawula ukunyuka okusha kwegazi, okungaholela ekuhloleni ikhanda, ukuhlukunyezwa, nokulahlekelwa kwegazi.
I-Carotid Artery iphoqa
I-carotid artery stenting (CAS) ihlanganisa i-catheter encane efakwe emithanjeni yegazi, evame ukuqala emthonjeni wesifazane emthonjeni, kuze kube emthini we-carotid. Lokhu kwenziwa ngaphansi komhlahlandlela we-fluoroscopic , ngakho-ke ochwepheshe angabona ukuthi benzani. Uma i-catheter isesikhundleni, i-stent ifakwe emthini wokusiza ukuyivula futhi uyigcine. Ngokuvamile, isikhathi sokuphumula esivela ku-CAS sisheshe kunaleso se-CEA.
Abantu abaningi bathanda umqondo we-carotid ophazamisayo ngoba ubonakala ungenangqondo kakhulu kune-endaro-ceretium endarterectomy. Kodwa-ke, ukuthukuthela akuzange kube khona isikhathi eside njengoba i-CEA, futhi ingozi nayo. Izifundo zakuqala zazibonakala zibonisa ukuthi izingozi zokugcoba zazikhulu kakhulu kune-CEA ngokujwayelekile. Kodwa-ke, lezi zifundo ziye zagxeka ngokuqhathanisa odokotela abangenalwazi abanamakhono okwenza ama-stents kudokotela abaningi abanolwazi okwenza i-CEA.
Ucwaningo lwe-2010 eNew England Journal of Medicine luye lwabonisa ukuthi ngenkathi ukugxuma kungase kuphumelele njenge-CEA ekusebenzeni kwamathambo okuvula, ingozi yokushaya isifo ehambisana nenqubo iphakeme kune-CEA, okungenani ngenyanga yokuqala emva kwenqubo.
Ukucatshangelwa Ukwelashwa
Isinyathelo sokuqala ukunquma ukuthi imuphi ukwelashwa ngaphandle kwemithi kuyadingeka nhlobo. Isici esiyinhloko sokwenza isinqumo kungakhathaliseki ukuthi isifo se-stenosis sesivele sibangele ukushaywa komzimba noma cha. Uma kungenjalo, kanti uma i-stenosis ingaphansi kuka-80%, odokotela abaningi bakhetha ukuphathwa kwezokwelapha kuphela. Uma kwenzeka isifo sohlangothi, kungase kube yisibonakaliso sokuthi ukwelashwa okunamandla kunesidingo. Uma lesi sifo sinkulu kakhulu, noma kunjalo, kungase kungabi khona okwanele ebuchosheni obunxele ukuze kulungiswe izingozi zenqubo.
Kusukela isingeniso salo ngasekupheleni kweminyaka ye-1990, ukuqhuma kwama-carotid kuye kwanda kancane kuye kwanda ukuthandwa. Manje Medicare ihlanganisa inqubo ngaphansi kwezimo ezikhethiwe. Ekugcineni, ukwelashwa okungcono kuncike kwizici ezihlukile zesiguli, odokotela, ngisho nomshuwalense.
Olunye ucwaningo luye lwabonisa ukuthi izici ezifana nobude be-stenosis nokuma kwe-plaque ne-blood vessel kungathinta ithuba lokuthi i-CAS iholele ekushayweni. Abantu asebekhulile ngokuvamile benza okungcono kakhulu nge-stent kunomuntu omncane, nakuba umuntu osekhulile enempilo angase enze kahle.
Umshuwalense udlala nesici. I-Medicare izovame ukumboza i-CAS yeziguli ezinomsoco onengozi enkulu ye-CEA okungenani okungenani i-70% stenosis. Ezinye izinhlobo ze-stenosis (cishe amacala angu-90%) zidinga ukunakekelwa kwenye indlela.
Ekugcineni, ukwenziwa kwezinqumo mayelana nendlela yokuphatha i-carotid stenosis kuyinto eyingqayizivele njengomuntu onesifo se-stenosis. Ucwaningo luvame ukungaqondakali, futhi ngenxa yokuthi kukhona imali okumele ihileleke ekukhethweni ngalunye, kungaba yinkinga ukuthola umbono ongakhethi. Ungesabi ukubuza odokotela abangaphezu kweyodwa ngemicabango yabo.
Imithombo:
I-Brott TG, et al. Ukuphefumula ngokumelene ne-endarterectomy ekwelapheni i-carotid-artery stenosis. N Engl J Med . 2010 Jul 1; 363 (1): 11-23. Epub 26 Meyi 2010.
I-Ropper AH, ama-Samuels MA. Adams kanye Nemigomo kaVictor ye-Neurology, 9th ed: I-McGraw-Hill Companies, Inc., 2009. iPhalamende likaMcCabe, u-O'Connor EJ.
U-Sharon Swain, uClaire Turner, uPippa Tyrrell, u-Anthony Rudd egameni leNkombandlela yokuThuthukiswa kweQembu, Ukuxilonga nokuphathwa kokuqala kokuhlaselwa okuphawulekayo kwesifo se-ischemic: isifingqo se-NICE isiqondiso, BMJ 2008; 337: a786, Julayi 24, 2008
Tu JV et al. Izingozi zokufa noma ukushaywa yisifo ngemuva kokuphela kwe-carotid endarterectomy: ukubonwa kwe-Ontario Carotid Endarterectomy Registry. Isibungu . 2003 Nov; 34 (11): 2568-73.
QAPHELA: Ulwazi olukulesi sayithi lunguzinhloso zemfundo kuphela. Akufanele isetshenziswe njengengxenye yokunakekelwa ngumuntu udokotela olayisenisi. Sicela ubheke udokotela wakho ukuze ahlolwe futhi aphathwe noma yiziphi izimpawu noma isimo sezokwelapha .