A cikin 'yan shekarun da suka wuce, magungunan sunyi juyin juya halin maganin cututtukan cututtuka . Sifofin sune nau'ikan matsi ne da aka sanya su a cikin maganin "bude bude" bayan maganin angioplasty . Kusan dukkan hanyoyin hanyoyin angioplasty a yau sun hada da shigar da sutura.
Manufar Tsarin
An tsara sifofin don rage matsala na restenosis , wanda yakan faru sau da yawa bayan angioplasty kadai.
Rashin farfadowa ya haifar da ci gaban tsohuwar nama a shafin yanar gizo na angioplasty, yiwuwar rashin tausayi da cutar da angioplasty yakan haifar da lokacin da yake ɗaukar takarda a atherosclerotic .
An sanya matakan farko ne daga karfe marasa tsabta (nau'ikan ƙarfe ne, ko BMS). Yawancin kwayoyi na yau da kullum suna shafe da kwayoyi da hana cikewar nama, kuma ta haka ne ya hana restenosis. Wadannan ana kiran su magungunan miyagun kwayoyi, ko DES. Siffofin - musamman DES - sun ƙaddamar da matsala ta mahimmanci.
Ta yaya aka sanya Sifofi?
An saka sifofin ta hanyar sanya wani sutura mai rushewa a kan wani balloon da aka kare a ƙarshen wani catheter. Cikakken yana ci gaba zuwa sashi na maganin da ya faru ne kawai cikin angioplasty, kuma an yi amfani da balloon, saboda haka yana fadada maɗaukaki a kan bango na maganin. Sai an cire balloon kuma an cire catheter, barin stent a wuri. Yawancin lokaci, ana amfani da kumbura na balloon da ake amfani da shi don fadada suturar ta hanyar yin amfani da angioplasty, don haka angioplasty / stenting yana cikin mataki daya.
Sifofi sun zo da yawa masu yawa da siffofi don ba da damar likitan zuciya ya zabi na'urar da zai fi dacewa da maganin mai haƙuri.
Rarraba Tare da Tsarin
Matsaloli zasu iya faruwa idan an saka wani sutura cikin rashin kyau a cikin maganin, ko kuma idan an yi amfani da wani ɓangaren girman girman ko siffar. Da zarar an sanya tsutsa a cikin maganin da ba za a iya cire shi ba, don haka matsalolin da suka shafi irin wannan matsala "matsala" suna da wuya a bi da su, kuma yana iya buƙatar kewaye tiyata .
Wannan damuwa yafi yawa a farkon kwanakin da ake amfani dasu, lokacin da kawai wasu nau'ikan nau'o'i sun kasance don zaɓar daga. Abin farin cikin, haɗarin rikitarwa daga mummunan aiki ya zama ƙasa da kashi 1% a yau.
Wani muhimmin ƙwarewar da aka gani da stents shine stent thrombosis.
Sanarwar Thrombosis
Yayin da sifofin sunyi nasara wajen rage babbar matsalar da ke hade da angioplasty - restenosis - sun gabatar da sabon matsala - stent thrombosis. Ƙararin yatsan cutar shi ne kwata-kwataccen kwata-kwata a cikin jigon jini, wanda ya haifar da yaduwar jini. Wannan mummunan abu ne sau da yawa masifa, haifar da infarction na sirri (ciwon zuciya) ko mutuwa. Abin farin ciki, rashin lafiyar kwayar cutar ta ƙananan ƙananan - muddin ana amfani da magungunan anti-platelet don hana jini clotting.
- Kara karantawa game da stent thrombosis.
Dukkan marasa lafiya da ke karbar sutura suna buƙatar sanya su a kan "farfadowa na maganin tarkon" (DAPT) tare da magungunan anti-platelet guda biyu don hana jini jini: aspirin , kuma daya daga cikin masu satar masu karɓa na P2Y12. Masu shinge na P2Y12 da suke amfani da su don hana stent thrombosis su ne clopidogrel ( Plavix ), prasugrel (M), da kuma ticagrelor (Brilinta).
DAPT yana dauke da hadarinsa, kuma akwai mai yawa rigingimu game da tsawon lokacin da marasa lafiya ya kamata su kasance a kan wadannan kwayoyi bayan sun sami karfin. Saboda yiwuwar marigayi thrombosis (wato, thrombosis na faruwa a shekara daya ko fiye bayan saiti), wasu hukumomi suna rokon likitoci su ci gaba da marasa lafiya a kan DAPT har tsawon shekaru, ko watakila har abada.
Layin Ƙasa
Labaran ƙasa shine cewa kwayoyin sun rage haɗarin haɗuwa, kuma sun sanya magungunan maganin cututtuka na jijiyoyin asali da kuma na yau da kullum.
Duk da haka, karɓar shinge yakan gabatar da sabon matsala - haɗarin kututturewa na stent thrombosis - kuma magance wannan hadarin ba tare da matsala ba.
Kowa wanda likita ya bada shawara ya kamata ya yi la'akari sosai game da hadarin da amfani da wannan farfasa, da kuma dukkan hanyoyin da za'a iya magance cututtuka na maganin jini.
- Karanta game da matsalar tare da stents.
- Shin kwayoyi suna da amfani ga zaluntawar angina?
- Karanta game da dukkanin hanyoyin maganin maganin cututtukan jini.
Sources:
Fischman, DL, Leon, MB, Baim, DS, et al. Misalin kwatancen jigilar jini tare da angioplasty na balloon a maganin cututtukan cututtuka na jijiyoyin jini. N Engl J Med 1994; 331: 496.
Colombo, A, Stankovic, G, Musa, JW. Zaɓin sifofin jini. J Am Coll Cardiol 2002; 40: 1021.
Mauri L, Kereiakes DJ, Yeh RW, et al. Shekaru goma sha biyu ko 30 na magungunan rigakafi biyu bayan maganin ƙwayoyi. N Engl J Med 2014; DOI: 10.1056NEJMoa1409312.
Columbo A da Chieffo A. Dual antiplatelet far bayan bayanan miyagun ƙwayoyin cuta - Yaya tsawon lokacin kula? N Engl J Med 2014; DOI: 10.1056 / NEJMe1413297.