Icho ichi chirongwa chakakosha chokurapa here?
Angioplasty uye kupisa simba zvakashandura nzira yekurapa chirwere cheyoroni , asi idzirapa dzakagadzirisa rudzi rutsva rwechinetso mumusanganiswa. Iyi ndiyo dambudziko rekudzoka - kuregererwa kudzivirirwa panzvimbo yekurapa. Mukutanga kwema 2000s, brachytherapy, kana chirwere chetachiona remishonga inonzi radiation, yakava mushonga mutsva wakavimbisa wekuzorodza.
Asi nepo brachytherapy yakanga iri (uye ichiripo) yakanyatsoshanda kubudirira, ikozvino yave yakanyanya kubviswa nekushandiswa kwemishonga-eluting stents .
Restenosis mushure mekunge angioplasty kana kunhuwa kunokonzerwa nekukura kwakanyanya kwezviviri panzvimbo yekurapa. Inokonzerwa nekupora kwakanyanya kuporesa, zvichiita kuwedzera kwe "endothelial" masero ayo anowanzoisa mishonga yeropa. Izvi zvinowedzera zvishoma zvishoma zvishoma nezvishoma zvinoita kuti arteri iwedzere.
Brachytherapy inogona kurapa restenosis nekuuraya masero emamwe uye kudzivirira humwe hutachiona hukura.
Brachytherapy Inoshandiswa Sei?
Brachytherapy inoshandiswa mukati mehutano hwemwoyo hwekati catheterization . Iyo mihiyoyo pachayo inopihwa nemhando yakakosha ye catheter yakagadzirirwa kushandiswa kwemairasi kubva mukati meyeri yeronary. Iko catheter inopinda mumaroto e coronary uye panguva yose yekuvhara kwechikonzero kunokonzerwa nekugara. Kana imwe nzvimbo yakatarwa "yakasungirirwa" ne catheter, mazairo anoshandiswa.
Mhando mbiri dzemasikirini anogona kushandiswa: gamma radiation uye radia beta. Zvose zviri zviviri mazairo emhepo zvinenge zvisina kuoma kushandisa, uye zvinoda kuvapo kwezvinhu zvakakosha muzvirairo, kutora matanho chaiwo ekuchengetedza, uye vanhu vakarovedzwa zvakanyanya, kazhinji zvinosanganisira radiation oncologist.
VanaCardiologists vakashandisa brachytherapy vanobvumirana kuti chinhu chikuru chekubudirira ndicho chiitiko cheanoshandisa. Aya maitiro akaoma anoda zvinopfuura zvinowanzozivikanwa ruzivo rwechiitiko chinopindira chirwere chemardi.
Kubudirira
Zvidzidzo zvekuchipatara zvakaratidza kuti brachytherapy inoshanda zvakanaka pakuburitsa restenosis mumaketari e coronary, uye mukuderedza dambudziko rekuwedzerazve. Mukuwedzera, zvidzidzo zvinoratidzika kuratidza kuti varwere vane njodzi yakakura yekuzorodzwa- (sevanhu vane chirwere cheshuga ) -kuda kuwana zvakanyanya kubatsirwa nemishonga yehutachiona.
Matambudziko
Brachytherapy haina chinetso-isina. Chimwe chinetso chinoshamisa chakaratidzwa ne brachytherapy chave chiri "kupera kwemaitiro" -kuonekwa kwezvitsva zvitsva kumativi ose emasvingo emharaunda (nzvimbo inobatwa nemirairo). Izvi zvinogadzirisa chironda, chinotora pakuonekwa kwebhodhu kana kuti "candy-wrapper" kana yakarongedzwa nechine angiogram, inokonzera kukanganisa kwakanyanya kunonetsa kwakaoma kurapa. Izvi zvinokonzerwa nemakumbo anowanzokonzerwa nekugadziriswa kwecatheter paanotarisira brachytherapy.
Uyewo, varwere vanobatwa ne brachytherapy vanoita kunge vane ngozi yakawanda yekugadziriswa kwegononi yeropa ( thrombosis ).
Kazhinji, kana kuputika kunoitika kuchitevera angioplasty kana kunhuwa, inowanzoitika mumazuva makumi matatu ekugadzirisa. Asi kupera kwemazuva makumi matatu (zvichiitika mushure mekutanga kwemazuva makumi matatu) kunoonekwa munenge 10 muzana yevarwere vanowana brachytherapy. Izvi zvinopedzisira zvinosanganiswa ne myocardial infarction (kurwisa kwemwoyo ) kana angina isina kusimba . Kuti ubatsire kuderedza dambudziko iri, ropa rakanyanyisa rinorudzirwa kwekunenge gore rimwe mushure mekubata brachytherapy.
Nei Brachytherapy Inowanzoshandiswa Nhasi?
Restenosis ndiyo yakanga iri dambudziko guru risina kugadziriswa mumazuva ekutanga eangioplasty uye inopisa, uye kwemakore anoverengeka brachytherapy yakaita senzira inovimbiswa yekugadzirisa kudzoka.
Zvisinei, ikozvino iko kushandiswa chete kazhinji.
Kuonekwa kwezvinodhaka-eluting stents nokukurumidza kwakaita kuti brachytherapy inenge isina kushanda. Zvidzidzo zvakaenzanirana nekuchengetedzwa nekubudirira kwebraschytherapy kune zvinodhaka-eluting stents pakurapa kugadzikana kwakaratidza zvakanaka zvakajeka kuti iyo stents inopa migumisiro yakanaka. Uyezve, mapurodiologist anononoka kuisa maronda, uye stents haitirwi kuora mwoyo, mari, uye unyanzvi hunokosha hunodiwa ne brachytherapy. Izvo hazvina kutora nguva yakareba ye brachytherapy kuti zviwande kubva pamepu.
Kunyange zvakadaro, brachytherapy inoshanda uye inogadzikana yakachengeteka uye yakagamuchirwa kuti ishandiswe neKudya uye Drug Administration. Zvimwe mashomanana anozivikanwa anoramba achizvipa sechisarudzo chekubata kurapa.
Nhasi, brachytherapy inowanzoonekwa sechisarudzo chete kune varwere vakambove vachidzokazve mushure mekusimudzira, uye mune zvinodhaka-eluting stents vakakundikana kugadzirisa dambudziko racho. Kugamuchira brachytherapy varwere ava vanoda kutumirwa kune rimwe remashoma masangano anoramba achipa rudzi urwu rwemishonga.
Sources:
Teirstein PS, Massullo V, Jani S, et al. Makore matatu emakiriniki nekutsvaga maitiro ekutsvaga mushure mekushandiswa kwemaitiro emagetsi: zviitiko zvekuongorora kwechirwere chechipatara. Circulation 2000; 101: 360.
Sapirstein W, Zuckerman B, Dillard J. FDA kugamuchirwa kwekodonary-artery brachytherapy. N Engl J Med 2001; 344: 297.
Holmes DR Jr, Teirstein PS, Satler L, et al. Kwemakore matatu kutevedza kweSISR (Sirolimus-Eluting Stents vs. Vascular Brachytherapy yeIn-Stent Restenosis) muedzo. JACC Cardiovasc Interv 2008; 1: 439.