I-Angioplasty-ebizwa nangokuthi "i-angioplasty ye-coronary coronary translatorinal", noma i-PTCA- inqubo yokwelapha okuhloswe ngayo ekuqedeni ukuvinjelwa ngaphakathi kwamathambo, ikakhulukazi emithanjeni ye-coronary .
I-Angioplasty isebenza ngokufaka i-ballo encane ngaphakathi komshini esakhiweni se- plaque ye- atherosclerotic , ukubeka phansi i-plaque nokunciphisa i-stenosis (ukuvimba) ngaphakathi komshini.
Cishe zonke izimo ze-angioplasty zihambisana nokufakwa kwesiteji .
Indlela Angioplasty Eyenziwa Ngayo
Ukuze enze i-angioplasty, udokotela usebenzisa i-catheter (ithanga elide, elincanyana, eliguquguqukayo) elinalo ibhaluni elifakwe eceleni. I-catheter idluliselwa ngaphesheya kwe-plaque eyenza ukuvinjelwa, futhi ibhaluni igcwele ngaphansi kwengcindezi. Ukwandisa ibhaluni kuphazamisa i-plaque ngokumelene nodonga lomthambo. Uma ibhaluni ihlanjululwe futhi isusiwe, le plaque ihlala okungenani icindezelwe, ngakho ukuvinjelwa kuncishisiwe.
Ngesikhathi i-angioplasty iqala ukusebenza njenge-stand-alone procedure, namuhla i-stent nayo ifakwa noma nini lapho i-angioplasty yenziwa emgodini we-coronary. I-stent yi-"scaffold" ekhulayo esiza ukusekela odongeni lomthambo esakhiweni se-angioplasty, ukuze kugcinwe i-plaque icindezelwe. I-stent ehlile ifakwa phezu kwebhaloli ngaphambi kokuba ifakwe.
Khona-ke, lapho ibhaluni ligcwala, i-plaque icindezelekile futhi i-stent yanda ngesikhathi esisodwa. Uma ibhaluni isilawuliwe futhi isusiwe, i-stent ishiywe endaweni, isisiza ukugcina i-plaque icindezelekile futhi umthambo uvuleke.
Uma Kuyasiza
I-Angioplasty iphumelela kakhulu ekunciphiseni izimpawu ze- angina esinezinzile .
Ngakho isizathu esiyinhloko sokwenza i-angioplasty emthonjeni we-coronary ukuphatha i-angina ehlala iphikelela naphezu kwemizamo yezokwelapha. Nakuba kungase kubonakale kumangalisa kuningi, i-angioplasty (ngisho nalapho i-stent ingeniswa) ayizange iboniswe ukuthi iphumelele kakhulu kunezokwelapha zokwelapha ekunciphiseni ingozi elandelayo ye- infarction ye-myocardial (ukushaya kwenhliziyo), noma ukuthuthukisa ukusinda. Ngakho isizathu esiyinhloko sokwenza i-angioplasty ukukhulula u-angina ozinzile oye waqhubeka naphezu kwemizamo yokuyiphatha ngemithi.
Isizathu sesibili i-angioplasty (kanye ne-stenting) esetshenziswa kaningi ekwelapheni isifo se-artery coronary in abantu abane- acon coronary syndrome (ACS). Ku-ACS, ukuvinjelwa okunamandla komthambo we-coronary kwenzeka ngoba i-plaque iphelile futhi i-clot yenziwe ngaphakathi kwe-artery. Uma i-ACS ivele, ukuhlaselwa kwenhliziyo kubonakala sengathi ngaphandle kokuba umthamo uvulwe. Ngesikhathi se-ACS, ubufakazi obukhona bubonisa ukuthi i-angioplasty ne-stenting ingasiza kakhulu ekuthuthukiseni imiphumela yomzimba jikelele.
Imishanguzo ye-coronary ayiyona kuphela imithwalo yegazi lapho i-angioplasty isetshenziselwa khona njalo ukuphatha amapayipi aphikisana ne-atherosclerotic. I-Angioplasty nayo isetshenziswa emithanjeni ye-carotid (eyinikeza ubuchopho), imishanguzo ye-renal (ehlinzeka izinso) kanye nemilenze yomlenze.
Izinkinga
Ukuhlukumeza okuvame kakhulu ukulandela i-angioplasty yedwa ukuphumula kwe-restenosis - ukwakheka kokuvimba okusha esakhiweni se-plaque egxilile. I-Restenosis iyinkqubo ehamba kancane kancane ebangelwa ukukhula okusha kwezicubu-mhlawumbe ekuphenduleni umonakalo owenziwe ngaphakathi nangaseduze nodonga lwe-angioplasty ngokwayo. Isimo sokuphumula sehlile kakhulu ngokusetshenziswa kwamagundane, ikakhulukazi izidakamizwa-eluting stents (DES), eziboshwe ngemithi evimbela ukukhula kwezicubu, ngaleyo ndlela ukunciphisa ukuphumula.
Ngaphambi kwesikhathi se-stents, i-restenosis ephuzile yenzeke ezigulini ezingaba ngu-30% ezazingenayo i-angioplasty yedwa.
Ukusetshenziswa kwe-stents enezinsimbi ezingenalutho kuncishise le ngozi engaphansi kuka-15%, futhi izidakamizwa-e-stuting zanciphisa iphinde ibe ngaphansi kuka-10%.
Inkinga encane engavamile, kodwa eyingozi kunazo zonke, yi-thrombosis (i-clotting blood) esakhiweni se-angioplasty / stenting. I-thrombosis enamandla isenzakalo esiphuthumayo futhi esivame ukuhlasela, okuyinto eyenza ukuvimbela okunamandla nokuphelele komthambo ochaphazelekayo. I-thrombosis ivame ukubonakala ngokushesha ngemva kwenqubo ye-angioplasty (okungukuthi, kungakapheli izinsuku ukuya kwamasonto). Kodwa-ke, uma i-stent efakwe ngesikhathi se-angioplasty (okuyinto ehlala ikhona njalo namuhla), ingozi ephansi ye-thrombosis iqhubeka isikhathi eside ezinyangeni eziningana emva kweminyaka. Ingozi ye-thrombosis iyancishiswa kakhulu ngokusetshenziswa kwezidakamizwa ezilwa nama-platelet- noma kunjalo, nazo zibeka ingozi.
Ezinye izinkinga ezingenzeka ngesikhathi se-angioplasty zihlanganisa ukulimala kwesitho esinikezwa yisitsha segazi esaphathwa (kuhlanganise nokuhlasela kwenhliziyo, ukulimala kwezinso noma ukushaya isisu), ukuguqulwa kwamagciwane noma ukuphuma kwamanzi.
Funda kabanzi mayelana nakho konke ukwelashwa kwesifo se-coronary artery .
> Imithombo:
> Abalobi / Amalungu e-Task Force, i-Windecker S, i-Kolh P, et al. Imikhombandlela ye-ESC / EACTS ka-2014 ku-Revascularization ye-Myocardial: I-Task Force ku-Myocardial Revascularization ye-European Society of Cardiology (ESC) kanye ne-European Association ye-Cardio-Thoracic Surgery (EACTS) Yakhelwa ngegalelo elikhethekile le-European Association of Percutaneous Cardiovascular Interventions ( EAPCI). I-Eur Heart J 2014; 35: 2541.
> Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC / AHA / AATS / PCNA / SCAI / STS Ukubuyekezwa okugxilwe kikhombandlela yokuHlola kanye nokuPhathwa kweziguli ezine-Stable Ischemic Heart Disease: Umbiko we-American College of Cardiology / American Heart Association Task Force on Guidelines Practice, kanye I-American Association ye-Thoracic Surgery, i-Preventive Cardiovascular Association Association, Society for Cardiovascular Angiography and Interventions, kanye neNhlangano Yezifo Ezihlinza NgamaTriracic. J Am Coll Cardiol 2014; 64: 1929.