Saukewa yana nufin sake saukewa na rikice-rikicen jini bayan da aka magance ta da angioplasty da stenting . Idan restenosis ya auku, yawanci yakan faru a cikin watanni 3 - 12 na hanya. Saboda restenosis yana sa tarihin ya zama ƙarami sake, alamun cututtuka na angina sau da yawa dawo.
An gane nakasar asalin matsala a farkon kwanakin angioplasty, yana faruwa a yawancin mutane 40 zuwa 50 na mutanen da aka bi da su tare da angioplasty kadai.
A gaskiya ma, dalili da aka haɓaka a farkon shine don rage yawan abin da ya faru na restenosis.
Har ila yau, ƙwayoyin sunyi nasara cikin yin hakan. Ko da tare da ƙarni na farko na ƙananan ƙarfe na ƙarfe (BMS), yawancin abubuwan da suka faru sun kasance sun rage (zuwa 20 - 30% cikin watanni 12). Daga bisani, ƙwayoyin magungunan ƙwayoyin cuta (DES) aka ƙaddamar don ƙoƙari su rage ragewa har ma kara. A cikin DES, ana amfani da kwayoyi da kwayoyi wanda ya hana ci gaban nama wanda zai kai ga restenosis.
Zamanin farko na DES ya rage yawan abin da ake samu na restenosis zuwa kimanin 15% a shekaru biyar. Newer DES sun rage ragowar restososis ko da kara, zuwa kimanin 5 - 7% a shekaru biyar.
Abin da ke haifar da gyarawa?
Angioplasty (da kuma jigilar stent, tun lokacin da yake tare da angioplasty) wani nau'i ne na ciwon nama. A lokacin angioplasty, wani kullun da ke dauke da raunin da aka kare shi ne ya wuce a cikin wani nau'in atherosclerotic a cikin maganin jini, sa'an nan kuma ya karbi balloon.
Hannar da ke cikin balloon ta rusa takarda, ta haka yana fadada buɗewar maganin. Wani sutura - wani tsari na ƙananan matsala - an fadada shi a shafin yanar gizo na angioplasty, don ci gaba da ƙarar daɗaɗɗa daga rushewa baya. Rubutun kalmomi (ko "smashing," idan ka fi so) na takarda ba hanya mai laushi ba ne, kuma kusan sau da yawa yakan haifar da rauni zuwa bango na jini.
Sake farfadowa yana faruwa ne saboda sakamakon ciwon nama a shafin yanar gizo. Ana iya tunanin shi a sakamakon wani tsari na warkarwa wanda ya biyo bayan cutar angioplasty. Kwayoyin endothelial wanda ke yin amfani da maganin jinƙan jini yana yaduwa a shafin yanar gizo. Idan wannan yaduwar kwayoyin cututtuka ya zama mai wuce kima, sel zasu iya hana tasirin jini a shafin yanar gizo.
Tsarin sakewa zai iya faruwa a sakamakon sabunta atherosclerosis - tsari wanda ya haifar da rikici na maganin jini a farkon wuri. Rashin farfadowa da lalacewa ta hanyar atherosclerosis yayi kokarin bayyana a cikin dogon lokaci bayan hanya - shekara daya ko fiye. Mafi yawan hankulan jiki, wanda yawanci ana gani a cikin watanni 6 kuma kusan a cikin watanni 12 bayan wannan hanya, yawanci yakan haifar da girma daga ciwon endothelial.
Restenosis vs. Thrombosis
Mahimmanci ba iri daya ba ne kamar yadda mutum ya kasance mai tsananin ciwo mai ɓarna - ƙwaƙwalwar kwatsam daga ɓacin jini. Abun ciwo mai tsanani shine yawan masifa, tun da yake yakan haifar da kwatsam da kuma cikar maganin ƙwayar jini. Haɗarin thrombosis ne mafi girma a farkon makonni ko kuma bayan watanni bayan saka jari, amma an rage sosai tare da yin amfani da kwayoyi masu ƙyamarta .
Har ila yau, akwai ƙananan ƙwayar cututtuka na stromate - thrombosis na faruwa a shekara daya ko fiye bayan da aka sanya stent - kuma a cikin 'yan shekarun nan ya bayyana cewa ana amfani da kwayoyi anti-platelet na tsawon shekara guda kuma mai yiwuwa ma ya fi tsayi . Hanyar da ta dace don hana tsutsarar kututturen marigayi, duk da haka, ya kasance rikici.
Ta Yaya Aka Yi Maimaita Tsayawa?
Duk da yake amfani da DES ya rage yawan abin da ya faru na stent restenosis, bai kawar da matsala ba.
Idan restenosis ya faru kuma yana samar da bayyanar cututtuka na angina, magani yawanci ya shafi wani maimaita hanya - yawanci, saka na biyu stent a cikin wannan wuri.
Harkokin lafiyar jiki (noninvasive) na angina ma madadin. Harkokin jinin jijiyoyin da ke kewaye da ita shine wani zaɓi ga mutanen da ke da tsabtace jiki, musamman ma idan restenosis yana bayan bayanan na biyu.
Takaitaccen
Tsarin sakewa shine asali babbar mahimmanci ta yin amfani da angioplasty da stents don cutar cututtukan jini. Yayinda fasahar fasaha ta inganta, haɓakaccen abu ya zama iyakance a matsayin matsala. Duk da haka, yin amfani da sifofin zamani ya gabatar da wani matsala na kulawa da kula da cututtukan cututtuka na jini - stent thrombosis. Hanya mafi kyau don rage haɗarin wannan sabon matsala har yanzu ana aiki.
> Sources:
> GD Ganga, Claessen BE, Caixeta A, et al. In-stent Restenosis a cikin Drug-eluting Stent Era. J Am Coll Cardiol 2010; 56: 1897.
> Piccolo R, Stefanini GG, Franzone A, et al. Tsaro da Inganci na Resolute Zotarolimus-eluting Stents Idan aka kwatanta da Everolimus-eluting Stents: Meta-bincike. Circ Cardiovasc cikin 2015; 8.
> Räber L, Wohlwend L, Wigger M, et al. Shekaru biyar na Abubuwan Hidima da Ayyukan Angiographic na Ƙididdigar Daidaita Sirolimus-eluting da Paclitaxel-eluting Stents: Sakamako na Sirolimus-Eluting Game da Paclitaxel-Eluting Stents for Coronary Revascularization LATE gwaji. Yanayin 2011; 123: 2819.