Restenosis waxaa loola jeedaa in si tartiib tartiib ah dib-u-dhicin oo loo maro halbowlaha wadnaha ka dib markii xannibaad lagu daaweyn jiray angioplasty iyo stenting . Haddii restenosis uu dhaco, waxay caadi ahaan dhacdaa 3 ilaa 12 bilood gudahood. Sababtoo ah restenosis waxay keenaysaa in halbowlaha mar labaad uu noqdo cidhiidhi, calaamadaha angina caadi ahaan waxay soo noqdaan.
Restenosis waxaa loo aqoonsaday inay tahay dhibaato la xiriirta maalmaha ugu horreeya ee cudurka angioplasty, oo ku dhaca 40 ilaa 50% dadka lagu daaweeyay cudurka angioplasty oo kaliya.
Xaqiiqdii, sababta keentay stents ayaa lagu sameeyay meesha ugu horeysa waxay ahayd in la yareeyo dhacdooyinka dibudhiska.
Si aad u badan, stents ayaa lagu guuleystay in sidaas la sameeyo. Xitaa jiilka koowaad ee stent metal ah (BMS), dhacdooyinka restenosis ayaa si weyn loo yareeyey (qiyaastii 20 - 30% 12 bilood). Ka dibna, stents-stents stents (DES) ayaa loo sameeyey si loo isku dayo in lagu yareeyo hudheelka nasashada xataa xitaa dheeraad ah. DES, stents ayaa lagu daboolay daroogo xakameynaya koritaanka unugyada taasoo horseed u ah restenosis.
Jiilka kowaad ee DES wuxuu yareeyey dhacdooyinka dibudhiska ilaa 15% shan sano. DES cusub ayaa hoos u dhigtay xaddiga nasashada ee xitaa intaa dheer, ilaa 5 - 7% shan sano.
Maxay Sababta Cudurka Qaban Karin?
Angioplasty (iyo meeleyn adag, tan iyo markasta waxaa weheliya angioplasty) waa nooc ka mid ah dhaawacyada unugyada. Inta lagu jiro angioplasty, kateetar qaadaya bakeeriga lakulmay waxaa lagu gudbiyaa lakabka atherosclerotic ee halbowlaha wadnaha, ka dibna bacda ayaa la jarjaray.
Sicir-bararka bakeeriyadu waxay ku cadaadisaa huurada, sidaas awgeed balaarinta furitaanka halbowlaha. Nidaam - nidaam ah caleemo yaryar - ayaa markaa lagu sii faafiyaa goobta xuubka angioplasty, si loo ilaaliyo halbowlaha wanaajinta in uu hoos u dhaco. Isku-dhafashada (ama "iftiimid", haddii aad doorbideyso) huuri ma aha habdhaqan wanaagsan, hadana had iyo jeer waxa uu abuuraa jahwareerka derbiga dhiigga.
Cudurka dib-u-dhaca wuxuu ku dhacaa natiijada ka soo baxda koritaanka unugyada goobta daaweynta. Waxay ku dhowaan kartaa in ay tahay natiijo ka timid habka "bogsashada" ka dib markii uu soo gaadhay naxdinta laf-dhabarka ee angioplasty. Unugyada endothelial ee caadi ahaan xariiqa xididada halbowlaha ayaa ku faafaya goobta dhaawacyada. Haddii koritaanka this unugyada endothelial uu noqdo mid xad-dhaaf ah, unugyada ayaa xakameyn kara weelka dhiigga goobta goobta stent.
Restenosis ayaa sidoo kale dhici karta inay sabab u tahay soo noqoshada atherosclerosis - habka sababay xannibaadda xididada dhiigga ee ugu horreeya. Restenosis oo ay keento atherosclerosis waxay u egtahay inay u muuqato wakhti aad u dheer kadib qaabsocodka - sanad ama ka badan. Cudurka dib-u-celinta ee caadiga ah, oo badanaa la arko 6 bilood gudahood, had iyo jeerba 12 bilood gudahood ka dib markii la raaco qalliinka, badanaa waxaa keena koritaanka unugyada.
Restenosis vs. Trombosis
Restenosis ma aha mid la mid ah sida xanuunka dareenka ee dareenka ah - foosha degdegga ah ee fareemka ka yimaada sameynta xinjir dhiig. Xinjir dhiig-xinjirowga ah ayaa badanaa waa dhacdo, maxaa yeelay waxay badanaa soo saartaa si lama filaan ah oo dhamaystiran oo ka soo baxa halbowlaha wadnaha. Khatarta xinjirowga thrombosis ayaa ah midka ugu sareeya toddobaadyada ama bilaha ugu horreeya ka dib meeleynta foosha, laakiin aad buu u yaraadaa marka la isticmaalo daawooyinka trigelet-inhibitorka .
Waxaa sidoo kale jira khatar yar oo halis dhab ah oo ah xinjirta dhiigga ee ugu dambeeya - xinjir dhiig oo ku dhacaya sannad ama ka badan kaddib markii stent la geliyay - iyo sanadihii ugu dambeeyay waxa muuqatay in daawooyinka ka hortagga uur-qaadida ay sii soconayaan ugu yaraan hal sano oo laga yaabo inay sii dheeraato . Si kastaba ha ahaatee, habka ugu wanaagsan ee looga hortagi karo xinjirowga dabadheerta ee dambe, si kastaba ha ahaatee, weli waa muran.
Sidee loo Qabaa Cudurka Dib-u-Dhaca?
Inkasta oo isticmaalka DES ay si weyn u yareeysay dhacdooyinka hargabka dib-u-dhaca, ma aysan tirtirin dhibaatada.
Haddii restenosis uu dhaco oo uu soo saaro calaamadaha angina, daaweyntu badanaaba waxay ku lug leedahay nidaam soo noqnoqonaya - caadi ahaan, gelinta stent labaad ee isla goobta.
Daaweynta (noninvasive) ee loo yaqaan angina waa mid kale. Qalliinka xididada loo yaqaan 'Coronary artery' waa qalab kale oo loogu talagalay dadka qaba sten restenosis, gaar ahaan haddii dib-u-soo-celinta dib-u-soo-noqoshada ka dib markii stent labaad.
Soo koobid
Restenosis wuxuu asal ahaan ka ahaa xaddiga ugu weyn ee loo adeegsado isticmaalka angioplasty iyo stents for cudurka halbowlaha wadnaha. Maadaama ay tiknoolajiyada hagaagsan tahay, restenosis hadda aad ayay u xadidan tahay dhibaato. Si kastaba ha ahaatee, isticmaalka stents casriga ah ayaa soo bandhigay dhibaatooyin kale oo maamulka ah si loo daryeelo cudurka halbowlaha wadnaha - xinjir dhiig leh. Sida ugu fiican ee loo yareeyo khatarta dhibaatadan cusub ayaa wali lagu shaqeynayaa.
> Ilo:
> Dangas GD, Claessen BE, Caixeta A, et al. Restenosis-ka stenosis-ka ee daawada Isticmaalka Daroogada. J Am Coll Cardiol 2010; 56: 1897.
> Piccolo R, Stefanini GG, Franzone A, et al. Badbaadinta iyo Waxtarka Nabadgelyada ee Zotarolimus-Dareemis aan Isticmaalaynin Marka la barbardhigo Everolimus-Stopping Stents: falanqaynta Meta. Wadnaha Cardiovasc Interv 2015; 8.
> Räber L, Wohlwend L, Wigger M, et al. Natiijooyinka Shaybaarka iyo Natiijooyinka ee Shan Sano ah ee Isbarbardhiga u Dhexeeya Sirolimus-Elektarooniga iyo Maareynta Dhaleeceynta: Codsiyada Sirolimus-Eluting Versus Paclitaxel-Eluting Stents loogu talagalay Dib-u-celinta Dib-u-celinta Qalabka LATE. Wareegga sanadka 2011; 123: 2819.