Kwiminyaka embalwa edlulileyo, ama-stents aguqule unyango lwe- coronary disease . Iintsimbi zinyango zetambo zetambo zengxowankulu ezibekwe kwisitya ukuba "zivulele" i-artery emva kwe- angioplasty . Cishe zonke iinkqubo ze-angioplasty namhlanje zibandakanya ukufakwa kwe-stent.
Injongo yeSenti
Iimpawu zenzelwe ukunciphisa ingxaki yokuphumla , eyenzeka rhoqo emva kokuba i-angioplasty yedwa.
I-Restenosis ibangelwa ukukhula kwamathambo omtsha kwisiza se-angioplasty, mhlawumbi esichukunyiswa yi-traum ephazamisayo i-angioplasty xa iphoxisa i- atherosclerotic plaque .
Iimbali zokuqala zenziwe ngeetsimbi ezingenakunqatywanga (i-stal metal okanye i-BMS). Amaninzi amaninzi anamhlanje afakwe iziyobisi ezivimbela ukukhula kweethambo, kwaye ke zivimbela ukuphumla. Ezi zibizwa ngokuba yiziyobisi ezinokuthi zikhuphe izilwanyana, okanye i-DES. Iintlobo - ngakumbi i-DES - ziye zanciphisa kakhulu ingxaki yokuphumla.
Zifaka njani iiStents?
Izitentshi zifakwe ngokubeka i-stent ehlile phezu kwebhaluni ehlaziyiweyo ekupheleni kathitter. I-catheter iqhubele phambili kwingxenyana yomthamo oye wangena nge-angioplasty, kwaye ibhaluni iboniswe, ngaloo ndlela ukwandisa i-stent ngokubhekiselele eludongeni lwe-artery. Ibhaluni iyahlanjululwa kwaye i-catheter isusiwe, ishiya isantya kwindawo. Ngokuqhelekileyo, ibhaluni yokunyuka kwamaxabiso esetyenziselwa ukwandisa i-stent nayo isetyenziselwa ukwenza i-angioplasty yangempela, ukwenzela ukuba i-angioplasty / stenting iyenziwe ngenyathelo elinye.
Amagqabini anokubuninzi obukhulu kunye nobunzima bokuvumela i-cardiologist ukuba ikhethe idivaysi eya kulungelelanisa umtshini wesigulane.
Iingxaki ezinamaqondo
Iingxaki ziyakwenzeka ukuba i-stent ibhalwe ngendlela engafanelekanga kwimitha, okanye ukuba i-stent yobukhulu obungalunganga okanye ifom isetyenziswa. Emva kokuba i-stent ifakwe kwi-artery ayinakususwa, ngoko ke iingxaki ezinxulumene nale "ntlupheko embi" zinzima ukunyanga, kwaye zinokufuna ukuhlinzwa kwangaphandle .
Le nkcenkcesha yayisetyenziswa rhoqo kwiintsuku zokuqala zokusetyenziswa kwamandla, xa kuphela iintlobo ezimbalwa zeentente ezikhoyo. Ngenhlanhla, umngcipheko weengxaki ezivela kwi-deployment deployment is ngaphantsi kwe-1% namhlanje.
Ingxaki ephawulekayo eyabonwa ngeentente iyisifo se-thrombosis.
I-stent Thrombosis
Nangona i-stents iphumelele ekunciphiseni ingxaki ephezulu enxulumene ne-angioplasty-restenosis - baye baqalisa ingxaki entsha-i-stent thrombosis. I-thrombosis ene-stent yinto yokutshatyalaliswa ngokukhawuleza kwe-coronary artery kwisiza sokufakwa kwesigxina, esibangelwa ngokukhawuleza kwakha i-blood clot. Esi siganeko senzeke ngokukhawuleza, okukhokelela kwisifo se-myocardial (intliziyo yesifo) okanye ukufa. Ngethamsanqa, iziganeko ze-stent thrombosis zincinci - ngokude nje ukuba izidakamizwa ezichasene nazo zisetyenziselwa ukuvimbela i-blood clotting.
- Funda kabanzi malunga ne-stent thrombosis.
Zonke izigulane ezitholakalayo zifuna ukuba zibekwe "kwiyeza ezimbini ezinxamnye ne-platelet" (DAPT) kunye nezidakamizwa ezimbini ezinxamnye neeplatele zokuvimbela ukuvalwa kwegazi: i- aspirin , kunye ne-block2 ye-receptor blockers. I-block2 ye-P2Y12 esetyenziselwa ukukhusela i-stent thrombosis yi-clopidogrel ( Plavix ), i-prasugrel (Umphumo), kunye ne-ticagrelor (i-Brilinta).
I-DAPT inomngcipheko wayo, kwaye kukho ingxabano eninzi malunga nokuba izigulane kufuneka zihlale ziphi iziyobisi emva kokuba zithole i-stent. Ngenxa yokuba kungenzeka ukuba i-stent thrombosis (i-thrombosis eyenzeka ngonyaka okanye ngaphezulu emva kokubekwa kwe-stent), ezinye iziphathimandla ziyanxusa oogqirha ukuba bagcine izigulane zabo ezigulisayo kwi-DAPT ubuncinane iminyaka emininzi, okanye mhlawumbi ngonaphakade.
Ngaphantsi
Umgca wecala kukuba i-stents inciphisa kakhulu ingozi yokuphumula, kwaye yenze unyango (nonxulumene) olungenasvasive lwe-coronary artery blockages ebonakalayo kwaye eqhelekileyo.
Nangona kunjalo, ukufumana i-stent ihlala iveza umcimbi omtsha-ingozi yokunyuka kwe-stent thrombosis - kwaye ukulawula kakuhle le mngcipheko akuyona inkathazo encinci.
Nabani na ugqirha wakhe uncoma ukuba i-stent ifuna ukuqwalasela ngokucokisekileyo ingozi kunye neenzuzo zonyango, kunye nazo zonke ezinye iindlela zokwelapha ezifumanekayo kwi-coronary artery disease.
- Funda malunga neengxaki ngeentente.
- Ngaba iindawo ezinomdla kakhulu zonyango lwe-angina?
- Funda malunga nazo zonke iinkqubo zokonyango zokugula komzimba.
Imithombo:
Fischman, DL, Leon, MB, Baim, DS, et al. Ukuthelekiswa okungahleliwe kwe-coronary stent placement kunye ne-balloon angioplasty ekwenzeni unyango lwe-coronary disease. N Engl J Med 1994; 331: 496.
Colombo, A, Stankovic, G, Moses, JW. Ukhetho lwee-coronary stents. J Am Coll Cardiol 2002; 40: 1021.
Mauri L, Kereiakes DJ, Yeh RW, et al. Ezilishumi elinambini okanye kwiinyanga ezingama-30 zonyango oluphambili lwe-antiplatelet emva kwe-drug-eluting stents. N Engl J Med 2014; INGXELO: 10.1056NEJMoa1409312.
I-Columbo A ne-Chieffo A. Ulwaphulo oluninzi lwe-antiplatelet emva kwe-drug-eluting stents-Kuze kube nini ukunyanga? N Engl J Med 2014; INGXELO: 10.1056 / NEJMe1413297.