Umnqweno wokuphelisa i-thrombosis yesantya
I-teknoloji entsha ye- stent iguqukela kwizinga elikhawulezayo. Nokuba izazi ze-cardiologists zinokuba neengxaki zokuzigcina zichanekile. Nantsi i-primer esheshayo kwiintlobo ezintsha zentsholongwane ngaphantsi kokuphuhliswa, kwaye kutheni kufuneka i-stents ephuculweyo.
Ziziphi Iintlobo Ezixhaswa Ukuba Ziyenze?
Injongo yonke ye-stents kukunceda ukukhusela i- restenosis kwi- artery coronary (okanye nayiphi na i-artery) emva kwe- angioplasty ye- atherosclerotic plaque .
Nge-angioplasty, i-catheter ibhaluni idluliselwa ngaphaya kommandla wokukhazamiseka kwintsimbi, kwaye ibhaluni inqwenela ukuchoboza i-plaque kwaye inciphise ukucinywa. I-stent yi-scaffold yesitrha esetyenziswe ngexesha le-balloon yokunyuka kwamaxabiso enika inkxaso yenkxaso, kwaye inceda ukugcina i-artery esanda kuphulukiswa.
UkuQuquka kweTeknoloji yasekuqaleni
Xa kusetshenziswe i-stents kuqala, baphumelele ekunciphiseni umngcipheko wokuphumula emva kwe-angioplasty malunga nesiqingatha, ukusuka kwi-20% ukuya kwi-10% kwiinyanga ezili-12 zilandela inkqubo. (Restenosis, xa kwenzeka, ngokuqhelekileyo kwenzeka ngonyaka.)
Ngomgudu wokunciphisa izinga lokuphumla kwakhona, abaphuculi be-stent baqala ukugubungela i-stents enesinyithi kunye nama-polymers aqukethe iziyobisi ezijolise ekuvimbeleni ukukhula kwezicubu kwisayithi se-stent. Ezi zicingo zibizwa ngokuba yizilwanyana ezixubileyo, okanye i-DES. (I-original, non-drug-stated stents, ngokuchaseneyo, yaziwa ngokuba yi-stents okanye i-BMS.) I-DES ziye zaphuhliswa zisebenzisa inani lamachiza, ngokuyinhloko paclitaxel, everolimus, okanye kwi-otarolimus.
I-DES iye yaphumelela kakhulu ekunciphiseni izinga lokuphumla kwi-5 - 6% ngonyaka. Nangona kunjalo, phakathi neminyaka embalwa ye-DES kuba "umgangatho wegolide" wonyango oluthile, ingxaki entsha yavela ekukhanyeni - i-thrombosis yasemva kwexesha.
Ingxaki ye-Thrombosis yaseLate
I-thrombosis ene-Stent iyakhelwe i-clot yegazi ngaphakathi kwiteyitha kwindawo ehlala kuyo.
I-thrombosis ihluke kwi-restenosis, yinto yokubuyiswa kwezicubu. I-Restenosis ngokuqinisekileyo iyinkathazo, kodwa ubuncinane xa kwenzeka kwenzeka ukuba yenzeke ngokuthe ngcembe kangangokuba ngokuqhelekileyo kukho ixesha lokunyanga. Ngokwahlukileyo, i-stent thrombosis iqhuba ngokukhawuleza, ngaphandle kwesilumkiso. I-stent thrombosis ivame ukukhokelela kwisithuba esipheleleyo somthamo, kwaye ngaloo ndlela ithambe ukuvelisa i- myocardial infarction (intliziyo yesifo) okanye ukufa ngokukhawuleza .
Ingxaki ye-thrombosis yokuqala (i-clot yegazi eqhubekayo kwiintsuku emva kweeveki emva kokugquma) yaqatshelwa kwiintsuku zokuqala, kwaye yaqwalaselwa ngempumelelo ngokulawula i- anti-platelet yezilwanyana ezinamandla emva kweenyanga ezimbalwa. Ngokusetyenziswa kwe-BMS, le ndlela ibonakala iyanele.
Nangona kunjalo, phakathi neminyaka embalwa yokusetyenziswa kwe-DES, ingxaki ye-thrombosis yasemva kwe-stent yafunyanwa-oko kukuthi, i-thrombosis ngokukhawuleza kwisayithi ye-stent eyenzeka ngonyaka okanye ezimbini emva kwenkqubo. I-thrombosis yesigxina esele ifikeleleke nje njengento eyingozi njengokuba i-stent thrombosis yangaphambili. Ukunciphisa umngcipheko, izazi ze-cardiologists ngoku zi-anti anti-platelet zonyango ubuncinane ngonyaka emva kokugquma, kwaye ukuba kunokwenzeka kakhulu ixesha elide (mhlawumbi ngonaphakade).
Ngenxa yokuba ukusetyenziswa kwezidakamizwa ezinqabileyo ezichanekileyo kubangela umngcipheko, umba we-stent thrombosis uye wabangela abaphuhlisi be-stent kwi-quest ukuba baqulunqe uhlobo olutsha lwe-stent oluphelisa okanye okungenani lunciphise le ngxaki.
Newer Stent Technologies
Iingcamango ezikhokelayo zokuthi kungani i-DES ingabangela i-stent thrombosis (emva kokuba i-DES ithenda ingabangeli le ngxaki) ijolise kwiingubo ze-polymer ezisetyenziswe kulezi ziqu. Injongo yengubo ye-polymer ukubeka isicatshulwa endaweni, kwaye ukuyikhupha kancane kancane kwiiveki okanye kwiinyanga ukwenzela ukuvimbela ukukhula kweethambo kunye nokuphumula. Xa isikhutshulwa isikhulu, kunjalo, i-polym neyona nto ayikho enye injongo.
Abaphandi ngoku bakholelwa ukuba iingubo ze-polym kwi-DES ziyakwazi ukwandisa ukuvuvukala nokulibazisa ukuphulukiswa kwisiza sokufakwa kwesigxina, okwandisa umngcipheko we-thrombosis.
Baye bathatha iindlela ezintathu eziqhelekileyo zokujongana nale ngxaki, kwaye iinkampani eziliqela ngoku ziphuhlisa ama-stents amasha zisebenzisa zonke iindlela ezintathu.
1) "Ulunge" iipolymesi ezihlala zihlala njalo. I-DES sele ikhona ngokusebenzisa iteknoloji yepolymer ehlaziywe. Ezi polymers ezintsha zibonakala zibangele ukuvuvukala okungaphantsi, kwaye zivumele ukuphulukiswa kwezicubu ezingcono kwiziko lonyango. Kukholelwa ukuba banciphisa kakhulu umngcipheko we-thrombosis. Ezi zibonda - ezibizwa ngokuba "sisizukulwana sesibili DES" - ngoku zisetyenziswa ngokubanzi emhlabeni jikelele.
2) Iipolymer ze-bioabsorbable. I-DES (ephuhlisiwe kwaye eyenziwe e-US) sele ifunyenwe eYurophu iminyaka emininzi isebenzisa isambatho se-polymer esithathiweyo (sinyamalala) kwiinyanga eziliqela, sishiya isitente esingenanto. Ngamanye amazwi, ezi zintlanzi zinikezela ngeenzuzo ze-DES ezinyangeni ezimbalwa zokuqala (xa kubonakala ukuba i-restenosis iyabonakala), kwaye ke i-BMS, enobungozi obuncitshisiweyo bokuthinteka kwe-thrombosis. Ngo-Oktobha, 2015, i-Synergy stent (i-Boston Scientific) yaba yiyokuqala ye-polymer e-bioabsorbable evunyelwe e-US.
Ucwaningo oluninzi lwenziwe ngokuthelekiswa kwe-DES bioabsorbable-polym DES kunye nesizukulwana sokuqala nesesibili DES. Ukuthelekiswa ne-DES izityalo zokuqala, i-thrombosis yentsholongwane yexesha elide iyancitshiswa nge-DES kunye ne-bioabsorbable-polymer DES. Nangona kunjalo, akukho nto ibonakaliswe apha ngolu hlobo lwe-bioabsorbable-polym DES yenza ngcono kunezizukulwana zesibini.
Ngaphezu koko, ubuncinane kude kube ngoku, i-DES yesibini kunye ne-polym DES entsha isacinga unyango olude kunye neziyobisi eziphambene neeplatelet.
3) Iimpawu ze-Bioresorbable. Iintlobo ziphantsi kophuhliso olupheleleyo ngokupheleleyo-oko kukuthi, i-stent epheleleyo iyabuyiselwa kwakhona kwaye ekugqibeleni iyanyamalala ngokupheleleyo. Kukholelwa ukuba iinzuzo ezinikezwa ngokugqithisa (umonakalo we-scaffold) ayisadingekile kwiinyanga ezilisithoba ukuya kwezi-12 emva kwenkqubo - i-stent ayikho enye injongo. Ngoko kutheni ungakwenzi uhambe? Kuye kwaphuhliswa iinguqu ezininzi ze-bioresorbable stents, kwaye zivavanywa kwiinkliniki ezikhutheleyo.
Ngaphantsi
Yonke ingunjineli engummangaliso esiyibonayo namhlanje kwi-teknoloji enobuchule iyamangalisa, kwaye kubonakala ngathi kuya kufikeleleka emva kwexesha okanye emva koko kuya kufumaneka ukuba kuphele ukuphelisa kokubili ukuphumla kunye ne-thrombosis. Kodwa kufuneka sigcine izinto ezimbalwa ngendlela ebonakalayo.
Okokuqala, yonke le misebenzi kunye nazo zonke ezo zophuhliso kwezobuchwepheshe zijoliswe ekujonganeni neengxaki ezimbini (i-restenosis kunye ne-stent thrombosis) ezibangelwa yimizamo yethu yokunyanga i- coronary artery disease (CAD) nge-angioplasty kunye ne-stents. Ukuba asizange 'sidinge' ukwenza le ndlela yenkqubo kuqala, le ndlela ayiyi kuyimfuneko.
Kwaye okwesibini, ngelixa i-cardiologists zikhawuleza kakhulu ukukhuthaza unyango olungenayo i-CAD, kufuneka sihlale sikhumbula ukuba ama-stents ayibonakalwanga kakhulu ekunciphiseni umngcipheko wokuhlaselwa kwintliziyo okanye ukufa kwizigulane ezininzi ezine-CAD ezizinzile. Ngaphambi kokuba uvumelane ne-stent, kufuneka uxoxe nodokotela wakho malunga nokuba i-stent iyakuba luncedo kwixesha lakho elizayo, okanye nokuba uya kuba wongeza nje ingxaki engapheliyo yokulawulwa kwinto esele uyenayo.
Imithombo:
Bangalore S, Toklu B, Amoroso N, et al. I-stare yensimbi, i-polymer yezidakamizwa ezihlala zikhupha i-stents, kunye nezidakamizwa ze-polymer ezikhupha izilwanyana ezikhupha izifo ze-coronary disease: i-meta-analysis analysis. BMJ 2013; 347: f6625.
I-Navarese EP, iTandjung K, uClaessen B, et al. Iziphumo zokukhusela kunye nokuphumelela kwezidakamizwa ze-polym eziqhubekayo ezikhupha izilwanyana kunye ne-polymer biolimus e-stuting e-stenti kwiinkqubo zonyango: uhlalutyo lwe-network meta-analysis. BMJ 2013; 347: f6530.
Stefanini GG, Byrne RA, Serruys PW, et al. Izidakamizwa ze-polymeric-eluting stents zenza umngcipheko we-stent thrombosis kwiminyaka engama-4 kwizigulane ezithintela ukungenelela kwe-coronary percutaneous: uhlalutyo oluhlanganisiweyo lwesigulane ngasinye somguli esivela kwi-ISAR-Test 3, ISARESTEST 4, kunye nee-LEADERS zilingo ezilandeleleneyo. I-Eur Heart J 2012; 33: 1214.