Chido chekubvisa kushandiswa kwemazuva ekupedzisira
Shanduro yepamusoro ye stent inoshanduka pakufamba kwenguva. Kunyange ma cardiologist vangave nechinetso chekuchengeta zvose zvakananga. Heino chimbichimbi chekutanga pamhando dzemarudzi matsva pasi pekugadziridzwa, uye nei zvakagadziridzwa stents dzinodiwa.
Ndezvipi Zvisingaiti Zvichifanira Kuitwa?
Icho chinangwa chose chemashutu ndechekubatsira kudzivirira restenosis mune chironga chegoni (kana chero arteri) mushure mekunge angioplasty yeatrosclerotic plaque .
Nengangioplasty, catheter yemabhaluni inopfuurira kune imwe nzvimbo yekudzivirira mune ariti, uye ibhoron inobvumira kupwanya iyo bundu uye kubvisa kuvhara. Nhengo yakagadzirwa nesimbi yakagadzirwa panguva yebhaluni inokonzerwa nehutachiona inobatsira kutsigira, uye inobatsira kuchengeta mishonga yakangobva kurapwa yakazaruka.
Kutanga kweEvolution yeSt Technology Technology
Apo stenti payakatanga kushandiswa, dzakabudirira mukuderedza dambudziko rekuchengetedzeka rinotevera angioplasty nehafu, kubva kune-20% kusvika kune 10% mukati memwedzi gumi nemaviri zvichienderana nekuita. (Restenosis, kana ichiitika, kazhinji inowanikwa mukati megore.)
Muchiedza chekuderedza chiyero che restenosis kunyange zvakadaro, vashandi vekugadzira vakatanga kuvhara simbi isina tsvina nemapurimi ane zvinodhaka zvinoshandiswa pakuvhara maitiro ekukura panzvimbo ye stent. Idzo idzi dzinonzi drug eluting stents, kana DES. (Chepakutanga, kwete-zvinokonzerwa nezvinodhaka, zvakasiyana, zvakazozivikanwa seisina metal stents, kana BMS.) DES dzakagadzirwa nokushandisa mishonga yemishonga, zvikuru paclitaxel, everolimus, kana yotarolimus.
DES vave vachibudirira chaizvo mukuderedza chiyero chekudzorera kusvika kune 5 - 6% mugore rimwechete. Zvisinei, mukati memakore mashomanana eD kuva "ndarama yepamusoro" ye stent therapy, dambudziko idzva rakasvika pakujekesa - kutora kwenguva refu.
Dambudziko reRate Thrombosis
Kushungurudza kwakasimba ndiko kuumbwa kweropa rinoputika mukati meyeri panzvimbo ye stent.
Thrombosis yakasiyana nekudzoka, iyo inonzi regrowth ye mhuka. Restenosis zvechokwadi chinetso, asi kana painoitika zvinowanzoitika zvishoma nezvishoma kuitira kuti kazhinji pane nguva yekurapa. Kusiyana neizvi, kushungurudzika kwakasimba kunowanzoitika kamwe kamwe, pasina chero kunyeverwa. Kutapisa kwakasimba kunowanzoendesa kune imwe nguva yakakwana yeriti, uye zvinowedzera kubudisa myocardial infarction (kurwisa kwemwoyo) kana kufa kamwe kamwe .
Dambudziko rekushongedza kwepakutanga (ropa rinoputika zuva rinoenda kumavhiki mushure mekusimudza) rakaonekwa mumazuva ekutanga ekudengenyeka, uye rakabudirira kugadziriswa nekupa simba rakasimba anti-platelet therapy kwemwedzi mishomanana mushure mekugomera. Nekushandiswa kweBMS, nzira iyi inoita seyakakwana.
Zvisinei, mukati memakore mashomanana ekushandiswa kwakapararira kwe DES, dambudziko rekudzivirira kwemazuva ekupedzisira rakagadziriswa - kureva kuti, kushungurudzika kwechimbichimbi panzvimbo ye stent inowanikwa gore kana maviri mushure mekuita. Kwapera nguva inonzi stent thrombosis inongova yakaipisisa seyokutanga stent thrombosis. Kuti kuderedze njodzi, mapurodiologist ikozvino anorayira ma anti-platelet therapy kwekanguva gore rapera, uye kana zvichiita kwenguva refu (zvichida nokusingaperi).
Nokuti kushandiswa kwakasimba kwema-anti-platelet drugs pachayo kunotakura dambudziko, nyaya yekuguma kwepent thrombosis yakatungamirira vanosimudzira stent pakuedza kutsvaga rudzi rutsva rwe stent runopedza kana kuti zvishoma kuderedza dambudziko iri.
Newer Stent Technologies
Nhungamiro inotungamirira yokuti nei DHI inogona kukonzera kushungurudzika kwenguva refu kwepo (asi DONI inotadza kusakonzera dambudziko iri) inotarisa pamapurasitiki ekushandiswa anoshandiswa pamatombo aya. Chinangwa chekuputira mapurisa ndechekubata mishonga yacho panzvimbo, uye kuisunungura zvishoma nezvishoma kwemavhiki kana mwedzi kuitira kuti kudzivisa kukura kwemaviri uye kubvisa. Kamwe kana mushonga wacho wakasunungurwa, zvisinei, iyo polymer haishumiri chimwe chinangwa.
Vanotsvakurudza ikozvino vanofunga kuti kupfeka kwema polymer paZV vanogona kuzviwedzera kuputira uye kunonoka kuporesa panzvimbo yekugara kwepamusoro, zvichiita kuti kuwedzere njodzi yekudengenyeka kwesimba.
Vakatora matanho matatu ekugadzirisa dambudziko iri, uye makambani akawanda ari kuumba iye zvino stents itsva achishandisa nzira idzi nhatu idzi.
1) "Zviri nani" mapurisa anogara akareba. DES zvave iko zvinowanika kushandisa shanduro yepolymmer inovandudzwa. Aya mapurogiramu matsva anoita seanoita kuti vasanyanya kuvhiringidza, uye kubvumira zviri nani kupora machira panzvimbo yekurapa. Zvinotendwa kuti zvinoderedza zvakanyanya dambudziko rekupedzisira kweprombosis. Aya mazamu - ayo anowanzonzi "wechizvarwa chechi DES" - iye zvino ari kushandiswa kwose kwose munyika.
2) mapurogiramu anonzi bioabsorbable. DES (yakagadzirwa uye yakagadzirwa muUnited States) yakave iripo muEurope kwemakore anoverengeka anoshandisa polymer kupfeka iyo inoputika (inopera) mumwedzi inoverengeka, ichisiya simbi isina tsvina. Mune mamwe mazwi, mazamu aya anopa zvikomborero zve DES kwemwedzi shomanana (apo restenosis inowanzoitika), uye zvino vanova BMS, nechinopedzisira chava pfupi chekugadzirisa kwenguva refu. MunaOctober, 2015, iyo Stnergy stent (Boston Scientific) yakava yekutanga bioabsorbable polymer stent inogamuchirwa muU.S.
Tsvakurudzo dzakawanda dzave dzichienzaniswa kuenzanisa bioabsorbable-polymer DES nekutanga uye yechipiri chizvarwa DES. Kuenzaniswa nechizvarwa chekutanga che DES, kusvitsa kwekupedzisira kwemaitiro kunopera nezvose zvechipiri chizvarwa DES uye bioabsorbable-polymer DES. Zvisinei, hapana chinoratidza pane ino kuti bioabsorbable-polymer DES inoita zviri nani pane yechizvarwa chechi DES.
Uyezve, zvisati zvasvika kure, zvose zvechizvarwa chechi DES ne polymer DES idzoramba ichichida kurapwa kwenguva refu nema anti-platelet drugs.
3) Zvinyorwa zvinoshandiswa. Nhengo dziri pasi pekugadzirwa zvakakwana zvachose - kureva, stent yose inodzokorora uye pakupedzisira inonyangarika zvachose. Zvinotendwa kuti zvikomborero zvinowanikwa nekusimudzira (iyo scaffold effect) haisati yadikanwa mapfumbamwe kusvika kumwedzi gumi nemaviri mushure mekugadzirisa - iyo stent haishumirizve chinangwa. Saka sei usina kuzviita? Shanduro dzakasiyana-siyana dzebioresorbable stents dzakagadziridzwa, uye dziri mumakiriniki anoshanda.
The Bottom Line
Zvose zvinoshamisa izvo zvatinotarisa zvichiitika mazuva ano mune teknolojia yepamusoro zvinonakidza, uye zvinoratidzika kuti munguva pfupi kana kuti gare gare ichave iripo iyo inoswedera pedyo nekubvisa zvose zvekudzorera uye kufungidzirwa. Asi isu tinofanira kuchengeta zvinhu zvishoma nenzira yakajeka.
Kutanga, mabasa aya ose uye zvipuriro izvi zvose mune teknolojia yepamusoro inotarisirwa kugadzirisa matambudziko maviri (restenosis uye stent thrombosis) iyo iyo inokonzerwa nekuedza kwedu kubata chirwere chetachiona (CAD) ne angioplasty uye stents. Dai tisina "kudiwa" kuita rudzi urwu rwekuita pakutanga, iyi yakadaro yekuedza kukuru hakuzodikanwa.
Uye chechipiri, apo mapurodiologist ave achinyanya kukurudzira kurapwa kwemaCAD, tinofanirwa kugara tichiyeuka kuti zvidimbu hazvina kuratidzirwa zvakanyanya kuderedza dambudziko rekurwadziwa kwemoyo kana kufa mune varwere vakawanda vane CAD yakagadzikana. Iwe usati wabvumirana ne-stent, unoda kutaura nachiremba wako pamusoro pekuti kana stent ichinyatsobatsira ramangwana rako, kana kuti panzvimbo iyo kana iwe uchangobva kuwedzera dambudziko idzva rekutarisira kune rimwe raunenge uine.
Sources:
Bangalore S, Toklu B, Amoroso N, et al. Simba resimbi yakasimbiswa, yakasimba polymer mishonga ekulingisa stents, uye biodegradable polymer mishonga inoshandura stents ye coronary artery chirwere: kusanganiswa kwekuenzanisa meta-analysis. BMJ 2013; 347: f6625.
Navarese EP, Tandjung K, Claessen B, et al. Zvokuchengetedza uye zvinobudirira zvibereko zvekutanga uye yechipiri chizvarwa chakasimba chemiti inonzi polymer inoshandura stents uye biodegradable polymer biolimus eluting stents mumagariro echechi: yakazara network meta-analysis. BMJ 2013; 347: f6530.
Stefanini GG, Byrne RA, Serruys PW, et al. Zvinyorwa zvinodhaka zvinokonzerwa nemishonga inokonzera mishonga-euting stents inoderedza ngozi yehutachiona hwepente mumakore mana muvarwere vanotarisana nemutauro unopindira: coronal analysis of data yega yega murwere kubva kuIAR-TEST 3, ISAR-TEST 4, uye LEADERS maitiro akasiyana-siyana. Eur Heart J 2012; 33: 1214.