Mumakumi mashoma makumi emakore adarika, stents yakashandura kurapwa kwekodonary artery disease . Nhengo dzesimbi dzakaiswa meshonga-mesh yakagadzirirwa iyo yakaiswa muyiti ye "prop open" musiti mushure mokunge angioplasty . Zvinenge zvose maitiro angioplasty nhasi anosanganisira kuiswa kwe stent.
Chinangwa cheStents
Nhengo dzakagadzirirwa kuderedza dambudziko rekuzorora , rinoitika kazhinji pashure pokunge angioplasty ari oga.
Restenosis inokonzerwa nekukura kwemashuga panzvimbo ye angioplasty, zvichida yakatsamwiswa nedambudziko iro angioplasty rinowanzokonzera kana rinomesa chikamu chinonzi atherosclerotic plaque .
Mhemberero yekutanga yakagadzirwa nematare asina kubviswa (bare metal stents, kana BMS). Yakawanda yemasikirini emazuva ano akafukidzwa nemishonga inobvisa maitiro ekukura, uye zvinodzivisa restenosis. Izvi zvinonzi drug eluting stents, kana DES. Nhengo - kunyanya DES - dzakanyanyisa kuderedza dambudziko rekuzorodza.
Ko Stents Inowanikwa sei?
Tsitsi dzinowanikwa nekuisa stent yakagumburwa pamusoro pebhokisi rakasvibiswa pamagumo ekateter. Iyo catheter inofambisa kusvika kune chikamu chetari iyo ichangobva kuitika angioplasty, uye ibhoron inogamuchirwa, nokudaro kuwedzera shato pamusoro pemadziro emuti. Bhaluni inobva yasvibiswa uye catheter inobviswa, ichisiya stent panzvimbo. Kazhinji, ibhaluni inflation iyo inoshandiswa kuwedzera iyo stent inoshandiswawo kuita yangioplasty chaiyo, kuitira kuti angioplasty / stenting iite munhanho imwe.
Idzo dzinouya muhukuru hwakawanda uye maumbirwo kuti zvibvumira kuti chirwere chegadhesi chigadzire chigadzirwa chinonyatsokodzera mishonga yemurwere.
Matambudziko Aine Stents
Zvinetso zvinogona kuitika kana stent iri panzvimbo isina kukodzera mukati meyeri, kana kana stent yekusaita ukuru kana chimiro inoshandiswa. Pane imwe nguva stent inowanikwa muyiti haikwanise kubviswa, saka zvinetso zvine chokuita ne "kushandiswa kwakashata" zvakaoma kubata, uye zvinogona kubvunzurudzwa .
Izvi zvinowanzowanzoitika mumazuva ekutanga ekushandiswa kwemaitiro, apo zvishoma chete zvakasiyana-siyana zve stents zvaivepo zvekusarudza kubva. Nenzira yakanaka, njodzi yezvinetso kubva pakuderera mashoma inodarika 1% nhasi.
Chimwe chinhu chinonyanya kukosha chinowanikwa ne-stents is stent thrombosis.
Stent Thrombosis
Nepo stents yave ichibudirira mukuderedza dambudziko guru rinosangana neangioplasty - restenosis - vakaunza dambudziko idzva - stent thrombosis. Kugadzikana kwakasimba ndiko kusvibiswa kwechibvumirano cheyoronary artery panzvimbo ye stent placement, inokonzerwa nekukurumidza kusangana kweropa. Izvi zvinowanzoitika zvinotyisa, zvichiita kuti myocardial infarction (kurwadziwa kwemoyo) kana rufu. Nenzira inofadza, chiitiko chekudzivirira kwe stent chinhu chiduku-chero bedzi kushandiswa kwema-plateletlet drugs kunodzivisa kuvhara ropa.
- Verenga zvakawanda pamusoro pehutano hwehutu.
Vose varwere vanowana stents vanoda kuiswa pa "maviri-anti-platelet therapy" (DAPT) neviri anti-platelet drugs kuti dzidzivise ropa rinoputika: aspirin , uye imwe yeP2Y12 receptor blockers. P2Y12 blockers iyo inoshandiswa kudzivirira stent thrombosis ndeye clopidogrel ( Plavix ), prasugrel (Mhinduro), uye ticagrelor (Brilinta).
DAPT inotakura zvinetso zvayo, uye kune mhirizhonga yakawanda pamusoro pehurefu hwevarwere vanorambira sei pamishonga iyi mushure mokugamuchira stent. Nemhaka yehutano hwekuguma kwehutachiona hwekupedzisira (kureva kuti, kuparara kunoitika kwegore kana kupfuura mushure mekugadziriswa kwepamusoro), mamwe hurumende ari kukumbira vanachiremba kuchengetedza varwere vavo vakagadzikana paDAPT kwemakore anoverengeka, kana zvichida nokusingaperi.
The Bottom Line
Chinhu chakakosha ndeyekuti mazamu akadzikisa zvikuru mukana wekuzorodza, uye akaita ((relatively) noninvasive kurapwa kwekoniyuta arteri blockages inogona kuitika uye nguva dzose.
Zvisinei, kugamuchira stent nguva dzose kunotanga dambudziko idzva-dambudziko rekushungurudzika kwepenzi - uye kunyatsogadzirisa dambudziko iri haisi dambudziko duku.
Ani naani ane chiremba anorayira kuti stent inoda kunyatsotarisisa kuipa uye kubatsirika kwechirapa ichi, pamwe chete nezvose zvinogona kurapwa zvinowanikwa muhutano hwehutano.
- Verenga pamusoro pechinetso ne stents.
- Izvo zvakakosha chaizvoizvo zvekurapa angina yakasimba?
- Verenga pamusoro pezvose zvinoshandiswa pakushandisa kurapwa kwechirwere chirwere.
Sources:
Fischman, DL, Leon, MB, Baim, DS, et al. Kuenzanisa kusinganzwisisiki kwekodonary- stent placement uye balloon angioplasty mukurapa keronary artery chirwere. N Engl J Med 1994; 331: 496.
Colombo, A, Stankovic, G, Mosesi, JW. Kusarudzwa kwe-coronary stents. J Am Coll Cardiol 2002; 40: 1021.
Mauri L, Kereiakes DJ, Yeh RW, et al. Mwedzi gumi nembiri kana makumi matatu eviri yekurwisa antiplatelet therapy mushure mekushandisa madhiragi-eluting stents. N Engl J Med 2014; DOI: 10.1056NEJMoa1409312.
Columbo A uye Chieffo A. Dual antiplatelet therapy pashure pemishonga-eluting stents-Inguva yakadini yekurapa? N Engl J Med 2014; DOI: 10.1056 / NEJMe1413297.