Izinketho zezoNyango kunye nokuPhepha kwiArtery yakho yeCarotid
Iingqungquthela ze-carotid ziyimithambo emibili yegazi eqhutyelwa emacaleni entanyeni yakho engqondweni yakho. Kanye kunye nemithambo emibili ye-vertebral emva kwentamo, i-carotids ivumela indlela yokuba ingqondo ifumane igazi eliyidinga oksijini.
Sibanzi
Njengaye nayiphi enye imirhoxo, i-carotids ingonakaliswa. Uxinzelelo lwegazi oluphezulu, i-cholesterol ephezulu, kunye nokutshaya ziindlela ezimbalwa zokunyusa umngcipheko we- plaque buildup kuma-carotids nakweminye imithwalo yegazi.
Xa i-plaque ikwakhiwa kwisitya senhliziyo, ingabangela ukuhlaselwa kwentliziyo . Xa i-plaque ikwakhiwa kwisitya segazi okanye ekuhambeni ukuya kwengqondo, ingabangela ukubetha .
I-Carotid stenosis iyigama elisetyenziselwa ukubonisa umzobo onqabileyo we-carotid. Xa i-plaque iyanciphisa umthambo we-carotid, inokubangela i-stroke ngeendlela ezimbini. Indlela eqhelekileyo kukuba inxalenye yeplate yokutyhulwa, yenze i- embolus , kwaye uhambe ngeemitha zegazi de ibe ibeke ingqino kwaye ibimbela ukuhamba kwegazi ibe yingxenye yengqondo. Iifama ziyafa ngenxa yokungabi nalutho lwe-oksijini-oku kuthiwa yi- ischemia .
I-Carotid stenosis nayo inganciphisa ukugeleza kwegazi kwingqondo ukuze ukuba uxinzelelo lwegazi lusehla, inxalenye yengqondo kuxhomekeke kuloo mzobo ayifumana igazi elaneleyo. Le meko ayifani ngokuqhelekileyo kunokuba ubumbano lwakhiwe ukubonelela izicubu kwizinto ezingaphezu kweyodwa kwixesha, njengoluhlobo oluthile lokulinganiswa nomonakalo we-ischemic.
Unyango
Ngenxa yokuba i-carotid stenosis yinto engumngcipheko wokubetha, ayikwazi ukunyanzelwa. Nangona kunjalo, kukho ukuphikisana malunga nendlela i-carotid stenosis ephathwa ngayo. Kukho iindlela ezintathu eziphambili zokuphatha i-carotid stenosis:
- unyango
- unyango ogqityiweyo (endaro-cereti endarterectomy)
- i- vascular stenting .
Unyango
Ukufika kwinqanaba, unyango lwe-carotid stenosis lucatshulwa kwihlabathi jikelele. Ngokomzekelo, ukuba i-artery carotid ingaphantsi kwe-50% yancinci, akukho mfuneko yokuba unyango olungenayo.
Kunoko, unyango lujolise ekuqinisekiseni ukuba i-plaque ayifuni. Izinto ezinobungozi ezifana nokutshaya, umfutho wexinzelelo kunye ne- cholesterol ephezulu kufuneka ziqwalaselwe. Njengamaxesha onke, ukutya kunye nokuzilolonga zihlala zibaluleke kakhulu.
Ukongezelela, ugqirha uya kubeka igalelo lenye igazi legazi elikhuselekileyo ukukhusela i-clot ekwakheni nasekukhutsheni i-artery okanye ukuya echotsheni. Ngokuxhomekeka kubukhulu becala, le nto inokuluhlula kwizinto ezinjenge-aspirin kwizinto ezifana neCourmadin.
Iingcali ezininzi ziyavuma ukuba unyango olugqithiseleyo luye lwaqhubeka luphucula ngokuhamba kwexesha, okwenza lukhetho olunamandla ngakumbi xa luqhathaniswa neenkqubo ezininzi ezingenayo.
Utyando loPhando
I-Carotid endarterectomy (CEA) yindlela yokucoca apho i-carotid ivuleka kwaye i-plaque ihlanjululwe. I-endarterectomy yeCarotid iye yafundwa kakuhle, kwaye idatha ibonisa ukuba iphucula ngokubanzi iziphumo phantsi kweemeko ezikhethiweyo. Le miqathango ibandakanya oku kulandelayo:
- I-carotid kufuneka ivalwe ngokukhulu (ngokuqhelekileyo iphezulu ngaphezu kwe-60%) kodwa ingavinjelwe ngokupheleleyo.
- Udokotela ogqirha kufuneka abe nezakhono, kunye neqondo elincinci lokufa elihlotshaniswa nophando.
- Isigulane kufuneka sibe nenye impilo enokwaneleyo yokuphucula kakuhle kwindlela yokuhlinzwa.
Iziphumo ezichaphazelekayo ze-CEA zibandakanya umngcipheko we-3 ukuya kwi-6 we-stroke okanye ukufa. Ubuncinane ngenyanga emva kwenkqubo, umngcipheko wokuhlaselwa kwentliziyo kubonakala ukhulu kwizigulane ezithobela i-CEA kunokuba i-carotid stenting (jonga ngezantsi). Kwakhona, ngenxa yokuba iimbilini ezithile zifumana igazi labo kule nqanawa, zingonakaliswa ngexesha lotyando. Ukongeza, ukuvula i-carotid kunokukhokelela ekulimaleni komonakalo ophezulu , okuyiyo xa ingqondo ingakwazi ukulawula ukunyuka okutsha kwegazi, okungabangela intloko, ukuthintela, kunye neengxaki ze-neurological.
I-Carotid Artery
I-Carotid artery stenting (CAS) ibandakanya i-catheter encinci ifakwe kwiimithanjeni zegazi, ngokuqhelekileyo iqala kwi-artery yomthi kwinqaba, ukuya kwi-artery carotid. Oku kwenziwa phantsi kolawulo lwe- fluoroscopic , ngoko ingcali inokubona oko benzayo. Emva kokuba i-catheter isesikhundleni, i-stent ifakwe kwisiteyithi ukunceda ukuyivula kwaye uyigcine. Ngokubanzi, ixesha lokubuyisela ukusuka kwi-CAS likhawuleza kunelo le-CEA.
Abantu abaninzi bathanda imbono ye-carotid ephaphazelayo kuba ibonakala ingenasiphelo kune-endaro-cardio endarterectomy. Nangona kunjalo, ukugquma okungazange kube ngeenxa zonke nje nge-CEA, kwaye kunobungozi. Izifundo zakuqala zazibonakala zibonisa ubungozi bokugqithisa kakhulu zikhulu kakhulu kune-CEA ngokubanzi. Nangona kunjalo, ezi zifundo zigxekwa ngokuthelekisa oogqirha abangenamava abenza amagqirha kubagqirha abanamava abenza i-CEA.
Ucwaningo luka-2010 kwi- New England Journal of Medicine lubonise ukuba ngelixa i-stenting ingaba yinkqubela njenge-CEA kwimibhobho yokuvula, umngcipheko we-stroke ohambelana nenkqubo uphezulu kune-CEA, ubuncinane ngenyanga yokuqala emva kwenkqubo.
Ingqwalasela yonyango
Isinyathelo sokuqala kukugqiba isigqibo sokuba ngaba nayiphi na unyango ngaphandle kweyeza kufuneka. Into ebalulekileyo ekuthathweni kwezigqibo nokuba ingaba i-stenosis sele ibangele isifo okanye ingabi. Ukuba akunjalo, kwaye ukuba i-stenosis ingaphantsi kwe-80%, oogqirha abaninzi bakhetha ukulawulwa kwezempilo kuphela. Ukuba kuqhutywe isifo, kungabonisa ukuba unyango oluninzi luyadingeka. Ukuba ulwabizo lukhulu kakhulu, nangona kunjalo, kunokungabi nokwaneleyo kwengqondo ekhohlo ukulungiselela iingozi zenkqubo.
Ukususela ekusungulweni kwayo ngasekupheleni kwee-1990, i-carotid stenting iye yazuza ngokukhawuleza. I-Medicare ngoku ijongene nenkqubo phantsi kweemeko ezikhethiweyo. Ekugqibeleni, unyango olungcono luya kuxhomekeka kwimimandla ekhethekileyo yesigulane, oogqirha, kunye ne-inshurensi.
Olunye uphando luye lwabonisa ukuba izinto ezifana nobude be-stenosis kunye nesimo se-plaque kunye nesitya segazi sinokuchaphazela ithuba lokuba i-CAS iholele ekubetheni. Abantu asebekhulile ngokubanzi banokwenza kakubi ngokugqithiseleyo kunomntu osemncinci, nangona umntu okhulile kakhulu usempilweni.
Ininshurensi nayo ibonisa into. I-Medicare iya kubandakanya i-CAS ngezigulane ezinezifo ezinomngcipheko omkhulu kwi-CEA onokungenani ubuninzi be-stenosis ka-70%. Ezinye iintlobo ze-stenosis (malunga nama-90% amatyala) kufuneka zigcinwe ngenye indlela.
Ekugqibeleni, ukwenziwa kwezigqibo malunga nendlela yokulawula i-carotid stenosis iyingqayizivele njengomntu onesifo se-stenosis. Uphando luhlala lucacile, kwaye kuba kukho imali enokubandakanyeka kwindlela nganye, kungenokuba nzima ukufumana ingcamango. Ungesabi ukucela ugqirha ongaphezulu kweengcinga zabo.
Imithombo:
Brott TG, et al. Ukuxhamla ngokubhekiselele ekupheleni kwe-endarterectomy ukwenzela unyango lwe-carotid-artery stenosis. N Engl J Med . 2010 Julayi 1; 363 (1): 11-23. Epub 26 Meyi 2010.
I-Ropper AH, i-Samuels MA. I-Adams kunye neMigaqo yeVictor ye-Neurology, 9-ed: I-McGraw-Hill Companies, Inc., 2009. Ilungu leMcCabe, u-O'Connor EJ.
U-Sharon Swain, uClaire Turner, uPippa Tyrrell, u-Anthony Rudd egameni leKhokelo loPhuhliso lweZikhokelo, ukuxilonga kunye nokulawulwa kokuqala kwe-stroke ephambili kunye nokuhlaselwa kwe-ischemic esingaphantsi kwexesha: isishwankathelo se-NICE, i- BMJ 2008; 337: a786, Julayi 24, 2008
Tu JV et al. Imiba yengozi yokufa okanye ukubetha emva kwe-carotid endarterectomy: ukubonwa kwe-Ontario Carotid Endarterectomy Registry. Stroke . 2003 Nov; 34 (11): 2568-73.
INKCAZELO: Ulwazi olukule ndawo lusezinjongo zemfundo kuphela. Akufanele isetyenziswe njengendawo yokunyamekelwa ngumntu ogqirha. Nceda ubone ugqirha wakho ukuze ufumane unyango kunye nonyango malunga nayiphi na impawu okanye imeko yonyango .