Yintoni iRestenosis?

Umxholo

• Ushwankathelo
• I-restenosis ye-stent (ISR)
• Iimpawu restenosis
• Oonobangela restenosis
• Umda we restenosis oza kwenzeka
• Uxilongo lwe restenosis
• Unyango lwe-restenosis
• Ukubonakala kunye nokuthintela i-restenosis

Ushwankathelo

I-Stenosis ibhekisa ekunciphiseni okanye ekuvaleni umthambo ngenxa yokwakheka kwento enamafutha ebizwa ngokuba yi-plaque (atherosclerosis). Xa isenzeka kwimithambo yentliziyo (imithambo yegazi), ibizwa ngokuba yimithambo yegazi stenosis.

I-Restenosis (“re” + “stenosis”) kuxa ilungu lomthambo ebelinyangwa ngaphambili ukuvaleka liba mxinwa kwakhona.

I-restenosis ye-stent (ISR)

I-Angioplasty, uhlobo longenelelo ngoncedo lwe-coronary (PC), yinkqubo esetyenziselwa ukuvula imithambo evaliweyo. Ngexesha lenkqubo, iscaffold esinyithi esincinci, esibizwa ngokuba yi-cardiac stent, siphantse sihlale sibekwe emthanjeni apho savulwa khona. I-stent inceda ukugcina umthambo uvulekile.

Xa inxalenye yomthambo ene-stent ivalekile, ibizwa ngokuba yi-in-stent restenosis (ISR).

Xa i-clot yegazi, okanye i-thrombus, isenzeka kwinxalenye yomthambo ene-stent, ibizwa ngokuba yi-in-stent thrombosis (IST).

Iimpawu restenosis

I-Restenosis, kunye okanye ngaphandle kwe-stent, yenzeka ngokuthe ngcembe. Ayizukubangela zimpawu de ukubhloka kubi ngokwaneleyo ukugcina intliziyo ingafumani mali incinci yegazi iyifunayo.

Xa iimpawu zikhula, zihlala zifana kakhulu neempawu zokuvalelwa koqobo ngaphambi kokuba zilungiswe. Ngokuqhelekileyo ezi ziimpawu zesifo se-coronary disease (CAD), ezinjengeentlungu zesifuba (angina) kunye nokuphefumula okufutshane.

I-IST ihlala ibangela iimpawu eziqubulisayo kunye nezibi. Ihlwili lidla ngokuthintela yonke imithambo yegazi, ngoko ke akukho gazi linokufikelela kwinxalenye yentliziyo elibonelelayo, elibangela isifo sentliziyo (i-myocardial infarction).

Ukongeza kwiimpawu zesifo sentliziyo, kunokubakho iimpawu zeengxaki ezinje ngokusilela kwentliziyo.

Oonobangela restenosis

Ibhaluni i-angioplasty yinkqubo esetyenziselwa ukunyanga i-coronary stenosis. Kubandakanya ukufakwa kwe-catheter kwindawo encinci yomthambo wecoronary. Ukwandisa ibhaluni kwincam yecatheter kutyhala i-plaque ecaleni, kuvula umthambo.

Inkqubo yonakalisa iindonga zomthambo. Izicubu ezintsha zikhula eludongeni olwenzakeleyo njengoko umthambo uphola. Ekugqibeleni, ulwelwesi olutsha lweeseli ezinempilo, ezibizwa ngokuba yi-endothelium, zigubungela indawo.

I-Restenosis yenzeka ngenxa yokuba udonga lwe-artery ye-elastic luhlala lubuyela umva kancinci emva kokuba solulelekile. Kwakhona, umthambo uyancipha ukuba ukukhula kwethishu ngexesha lokuphilisa kugqithisile.

I-Bare metal stents (BMS) zaphuhliswa ukunceda ukumelana notyekelo lokuvula kwakhona lomthambo lokuvala ngelixa liphilisa.

I-BMS ibekwe ecaleni kodonga lwemithambo xa ibhaluni inyuselwa ngexesha le-angioplasty. Ithintela iindonga ukuba zingabuyeli umva, kodwa ukukhula okutsha kwethishu kwenzeka ekuphenduleni ukwenzakala. Xa kukhula kakhulu izicwili, umthambo uqala ukuncipha, kwaye i-restenosis inokwenzeka.

Iziyobisi ezisebenzisa iziyobisi (i-DES) ngoku zezona zisetyenziswa ngokuxhaphakileyo. Bayinciphisile kakhulu ingxaki ye-restenosis, njengoko kubonwe ngamazinga e-restenosis afunyenwe kwinqaku lika-2009 elipapashwe kwi-American Family Physician:

• ibhaluni i-angioplasty ngaphandle kwe-stent: iipesenti ezingama-40 zezigulane zenze i-restenosis
• I-BMS: Iipesenti ezingama-30 ziphuhlise i-restenosis
• I-DES: ngaphantsi kweepesenti ezili-10 zavelisa i-restenosis

I-atherosclerosis nayo inokubangela i-restenosis. I-DES inceda ukuthintela i-restenosis ngenxa yokukhula kwethishu entsha, kodwa ayichaphazeli imeko ebangelwe yi-stenosis kwasekuqaleni.

Ngaphandle kokuba imeko yakho yomngcipheko itshintshe emva kokubekwa kwe-stent, i-plaque iya kuqhubeka nokwakha kwimithambo yakho ye-coronary, kubandakanya ne-stents, enokuthi ikhokelele kwi-restenosis.

I-thrombosis, okanye i-clot yegazi, inokubumba xa izinto ezijiyayo egazini zinxibelelana nento engaqhelekanga emzimbeni, enje ngestent. Ngethamsanqa, ngokuka, i-IST ikhula kuphela malunga neepesenti enye yemithambo yegazi.

Umda we restenosis oza kwenzeka

I-Restenosis, kunye okanye ngaphandle kokufakwa kwe-stent, ihlala iphakathi kweenyanga ezintathu ukuya kwezintandathu emva kokuba kuvulwe umthambo kwakhona. Emva konyaka wokuqala, umngcipheko wokukhula kwe-restenosis ukusuka ekukhuleni okugqithisileyo kwezicubu mncinci kakhulu.

I-Restenosis evela kwi-CAD engaphantsi ithatha ixesha elide ukukhula, kwaye ihlala iqhubeka ngonyaka okanye nangaphezulu emva kokuba unyango lwe-stenosis yoqobo lunyangiwe. Umngcipheko we-restenosis uyaqhubeka de kuncitshiswe umngcipheko wesifo sentliziyo.

Ngokuka, uninzi lwe-ISTs lwenzeka kwiinyanga zokuqala emva kokubekwa, kodwa kukho umngcipheko omncinci, kodwa obalulekileyo, kunyaka wokuqala. Ukuthatha abacoci begazi kunokunciphisa umngcipheko we-IST.

Uxilongo lwe restenosis

Ukuba ugqirha wakho ukrokrela i-restenosis, baya kusebenzisa uvavanyo olunye kwezintathu. Olu vavanyo lunceda ukufumana ulwazi malunga nendawo, ubungakanani, kunye nezinye izinto ezinokubangela ukuba uvaleke. Bazi:

• I-angiogram yeCoronary. Idayi ifakwe kwi-artery ukuveza iibhloko kunye nokubonisa ukuba igazi lihamba njani kwi-X-ray.
• I-ultrasound yangaphakathi. Amaza esandi akhutshwa kwi-catheter ukwenza umfanekiso wangaphakathi we-artery.
• Ukuhambelana komanyano kwitomografi. Amaza okukhanya akhutshwa kwi-catheter ukwenza imifanekiso enesisombululo esiphakamileyo somthambo.

Unyango lwe-restenosis

I-Restenosis engabangeli iimpawu zihlala zingafuni naluphi na unyango.

Xa iimpawu zibonakala, zihlala zisiba mandundu, kungoko kukho ixesha lokunyanga i-restenosis ngaphambi kokuba umthambo uvale ngokupheleleyo kwaye ubangele isifo sentliziyo.

I-Restenosis kwimithambo ngaphandle kwe-stent ihlala iphathwa nge-balloon angioplasty kunye nokubekwa kwe-DES.

I-ISR ihlala iphathwa ngokufakwa kwesinye istent (ihlala i-DES) okanye i-angioplasty kusetyenziswa ibhaluni. Ibhaluni yambathiswe ngamayeza asetyenziswa kwi-DES ukuthintela ukukhula kwezicubu.

Ukuba i-restenosis iyaqhubeka ukwenzeka, ugqirha wakho unokujonga i-coronary artery yokuhlinzwa (CABG) ukunqanda ukubeka ii-stents ezininzi.

Ngamanye amaxesha, ukuba ukhetha ukungabinayo inkqubo okanye utyando okanye unganganyamezeli kakuhle, iimpawu zakho ziya kunyangwa ngamayeza wedwa.

I-IST phantse ihlala ingxamisekile. Ukufikelela kwiipesenti ezingama-40 zabantu abane-IST abasindanga kuyo. Ngokusekwe kwiimpawu, unyango lwe-angina olungazinzanga okanye isifo sentliziyo siqalisiwe. Ngokwesiqhelo i-PCI yenziwa ukuzama ukuvula umthambo ngokukhawuleza kunye nokunciphisa ukonakala kwentliziyo.

Kungcono ukuthintela i-IST kunokuzama ukuyinyanga. Kungenxa yoko le nto, kunye neasprini yemihla ngemihla yobomi, unokufumana ezinye izinciphisi zegazi, njengeclopidogrel (Plavix), prasugrel (Effient), okanye ticagrelor (Brilinta).

Ezi zicoci gazi zihlala zithathwa ubuncinci benyanga enye, kodwa zihlala unyaka omnye okanye nangaphezulu, emva kokubekwa.

Ukubonakala kunye nokuthintela i-restenosis

Itekhnoloji yangoku yenze ukuba kuncinci amathuba okuba ubuye ube ne-restenosis ukusuka ekukhuleni kwezicubu emva kwe-angioplasty okanye ukubekwa kwe-stent.

Ukubuya ngokuthe ngcembe kweempawu obukade unazo ngaphambi kokuthintela kokuqala emthanjeni luphawu lokuba i-restenosis iyenzeka, kwaye kuya kufuneka ubonane nogqirha wakho.

Akukho nto ingako onokuyenza ukukhusela i-restenosis ngenxa yokukhula kakhulu kwezicubu ngexesha lokuphilisa. Nangona kunjalo, unokunceda ukukhusela i-restenosis ngenxa yesifo se-coronary disease.

Zama ukugcina indlela yokuphila esempilweni ebandakanya ukungatshayi, ukutya okusempilweni kunye nokwenza umthambo ngokulinganisela. Oku kunokunciphisa umngcipheko wokwakhiwa kwamacwecwe kwimithambo yakho.

Akunakulindeleka ukuba ufumane i-IST, ngakumbi emva kokuba une-stent inyanga enye okanye nangaphezulu. Ngokungafaniyo ne-ISR, nangona kunjalo, i-IST ihlala ibaluleke kakhulu kwaye ihlala ibangela iimpawu ngesiquphe zokuhlaselwa sisifo sentliziyo.

Kungenxa yoko le nto kuthintela i-IST ngokuthatha izicoci gazi okoko ugqirha ekucebisa ukuba kubaluleke kakhulu.