He aha ka Restenosis?

Anter

• Hōʻike Overview
• Restenosis in-stent (ISR)
• Nā ʻōuli o restenosis
• Nā kumu o ka restenosis
• Ka manawa manawa no ka restenosis e kū
• Kānāwai o restenosis
• Iapaau ana o restenosis
• Outlook a me ka pale ʻana i ka restenosis

Hōʻike Overview

ʻO Stenosis e pili ana i ka hoʻopili ʻana a i ʻole ke keʻa ʻana o ke aʻa ma muli o ke kūkulu ʻia ʻana o kahi mea momona i kapa ʻia he plaque (atherosclerosis). Ke hiki i nā aʻa o ka puʻuwai (nā aʻa coronary), ua kapa ʻia ʻo stenosis coronary artery.

ʻO Restenosis ("re" + "stenosis") ʻo ia ka wā o kahi ʻāpana o ke aʻa i mālama mua ʻia no ka blockage e lilo hou i piliki.

Restenosis in-stent (ISR)

ʻO Angioplasty, kahi ʻano o ke kōkua coronary percutaneus (PCI), kahi hana e wehe ai nā aʻa i ālai ʻia. I ka wā o ke kaʻina hana, kahi scaffold metala liʻiliʻi, i kapa ʻia he stent cardiac, aneane kau ʻia i ke aʻa kahi i wehe hou ʻia. Kōkua ka stent i ka hāmama o ke aʻa.

Ke ālai ʻia kahi ʻāpana o ke aʻa me kahi stent, kāhea ʻia ia i-stent restenosis (ISR).

Ke kūpulu kahi koko, a thrombus paha, i kahi ʻāpana o ke aʻa me kahi stent, kapa ʻia kahi thrombosis in-stent (IST).

Nā ʻōuli o restenosis

ʻO Restenosis, me ka ʻole o kahi stent, e hele mālie. ʻAʻole ia e hoʻokumu i nā hōʻailona a hiki i ka maikaʻi o ka blockage e mālama i ka puʻuwai mai ka loaʻa ʻana o ka nui o ke koko e pono ai.

Ke hoʻomohala nā ʻōuli, ʻano like loa lākou me nā ʻōuli ke kumu i hoʻopaʻa ʻia ma mua o ka hoʻopaʻa ʻia ʻana. ʻO ka maʻamau kēia mau ʻōuli o ka maʻi o ke aʻa koko (CAD), e like me ka ʻeha o ka umauma (angina) a me ka hanu liʻiliʻi.

Hoʻokumu pinepine ʻo IST i nā hōʻailona hōʻeha a koʻikoʻi. Pākuʻi ka mea paʻa i ke aʻa korona holoʻokoʻa, no laila ʻaʻohe koko e hiki i ka ʻāpana o ka puʻuwai e hoʻolako ai, e hōʻeha i ka puʻuwai (myocardial infarction).

Ma waho aʻe o nā hōʻailona o ka puʻuwai puʻuwai, aia kekahi mau ʻōuli o nā pilikia e like me ka puʻuwai puʻuwai.

Nā kumu o ka restenosis

ʻO ka balloon angioplasty ke kaʻina hana i hoʻohana ʻia e mālama ai i ka stenosis coronary. Hoʻopili ia i ka wili ʻana i kahi catheter i loko o ka ʻāiki o ka ʻāpana coronary. ʻO ka hoʻonui ʻana i ka pāluna ma ka piko o ka catheter e pahu i ka pā i ka ʻaoʻao, e wehe ana i ke aʻa.

Hoʻopōʻino ke kaʻina hana i nā paia o ke aʻa. Ulu nā mea hou i ka paia ʻeha i ka hoʻōla ʻana o ke aʻa. ʻO ka hopena, he uhi hou o nā keena olakino, i kapa ʻia endothelium, uhi i ka pūnaewele.

Hana ka Restenosis no ka mea e neʻe mālie nā paia o ke aniani elima i hope o ka hāmama ʻana. Pēlā nō, e hoʻopili ka aʻa inā ulu nui ka meaola i ka wā o ka hoʻōla.

Ua hoʻomohala ʻia nā stent metal stare (BMS) e kōkua i ke kūʻē ʻana i ka hana o ke aʻa i wehe hou ʻia e hoʻōla ana.

Hoʻokomo ʻia ka BMS ma ka paia o ke aʻa ke hoʻonui ʻia ka pāluna i ka angioplasty. Pale ia i nā paia mai ka neʻe hou ʻana i loko, akā kū mau ka ulu o nā mea hou i pane i ka ʻeha. Ke ulu a nui nā mea, hoʻomaka ke aʻa o ka aʻa, a hiki i ka restenosis ke hana.

ʻO nā stent drug-eluting (DES) i kēia manawa nā stent i hoʻohana mau ʻia. Ua hoʻemi nui lākou i ka pilikia o ka restenosis, e like me ka ʻike ʻia e nā helu restenosis i loaʻa ma kahi ʻatikala 2009 i paʻi ʻia ma American Family Physician.

• balloon angioplasty me ka stent ʻole: 40 pakeneka o nā maʻi i hoʻomohala restenosis
• BMS: 30 pakeneka hoʻomohala restenosis
• DES: ma lalo o 10 pākēneka i hoʻomohala restenosis

Hiki i ke Atherosclerosis ke hana i ka restenosis. Kōkua kahi DES i ka pale ʻana i ka restenosis ma muli o ka ulu ʻana o nā mea hou, akā ʻaʻole ia e hoʻopili i ke ʻano o ke kumu i hoʻokumu i ka stenosis ma mua.

Inā ʻaʻole e loli kāu mau pilikia ma hope o ke kau ʻana, e hoʻomau ka plake i loko o nā aʻa o kou coronary, me nā stents, i hiki ai i ka restenosis.

Hiki ke hana i kahi thrombosis, a i ʻole ke koko, ke hoʻopili ʻia nā mea i loko o ke koko me kahi mea ʻē i ke kino, e like me ka stent. ʻO ka mea pōmaikaʻi, e like me ka, hoʻomohala ʻo IST ma kahi o 1 wale nō pākēneka o nā stent arter coronary.

Ka manawa manawa no ka restenosis e kū

ʻO Restenosis, me ka ʻole o ka hoʻonohonoho stent, hōʻike pinepine ʻia ma waena o ʻekolu a me ʻeono mau mahina ma hope o ka wehe hou ʻia ʻana o ke aʻa. Ma hope o ka makahiki mua, heʻuʻuku ka makaʻu o ka hoʻomohala ʻana i ka restenosis mai ka ulu ʻana o nā mea nui.

Hoʻomaha ʻo Restenosis mai ke kumu o CAD i ka lōʻihi o ka hoʻomohala ʻana, a pinepine ka hana ʻana i hoʻokahi makahiki a ʻoi paha ma hope o ka mālama ʻia ʻana o ka stenosis kumu. Ke hoʻomau nei ka makaʻu o ka restenosis a hiki i ka hoʻemi ʻia ʻana o nā kumu pilikia no ka maʻi puʻuwai.

Wahi a ka, ka hapanui o nā IST e hana i nā mahina mua ma hope o ke kau ʻana, akā aia ka liʻiliʻi, akā nui, ka makaʻu i ka makahiki mua. Hiki i ka lawe ʻana i nā mea lahilahi ke hōʻemi i ka makaʻu o IST.

Kānāwai o restenosis

Inā manaʻo kāu kauka he restenosis, e hoʻohana maʻamau lākou i hoʻokahi o ʻekolu mau hoʻokolohua. Kōkua kēia mau hoʻāʻo e kiʻi i ka ʻike e pili ana i ka wahi, ka nui, a me nā ʻano ʻē aʻe o kahi paʻa. O lākou:

• Angiogram coronary. Hoʻokomo ʻia ka kala i loko o ke aʻa e hōʻike i nā ālai a hōʻike i ke ʻano o ke kahe o ke koko ma kahi X-ray.
• ʻO ke ultrasound Intravascular. Kuhi ʻia nā nalu kani mai kahi catheter e hana i kiʻi o loko o ke aʻa.
• ʻO ka tomography coherence optical. Hoʻopuka ʻia nā nalu māmā mai ka catheter e hana i nā kiʻi hoʻonā kiʻekiʻe o loko o ka aʻa.

Iapaau ana o restenosis

ʻO ka Restenosis kumu ʻole nā ​​hōʻailona ʻaʻole pono i kahi lapaʻau.

Ke ʻike ʻia nā ʻōuli, hele a mānoanoa lākou, no laila aia ka manawa e mālama ai i ka restenosis ma mua o ka paʻa ʻana o ke aʻa a hana i kahi puʻuwai puʻuwai.

Hoʻomaʻamaʻa pinepine ʻia ka Restenosis i kahi aʻa me ka stent ʻole me ka angioplasty balloon a me ka hoʻonohonoho DES.

Hoʻomaʻamaʻa pinepine ʻia ʻo ISR me ka hoʻokomo ʻana o kahi stent (maʻa mau he DES) a i ʻole angioplasty me ka hoʻohana ʻana i kahi pāluna. Hoʻopili ʻia ka baluna me nā lāʻau i hoʻohana ʻia ma kahi DES e kāohi ai i ka ulu ʻana o nā mea.

Inā hoʻomau ka restenosis, hiki i kāu kauka ke noʻonoʻo i ke kahakaha bypass arter coronary (CABG) e hōʻalo i ke kau ʻana i nā stent he nui.

I kekahi manawa, inā makemake ʻoe ʻaʻole e loaʻa kahi hana a i ʻole ke ʻoki ʻana a i ʻole ʻaʻole e hoʻomanawanui iā ia me ka maikaʻi, e mālama ʻia kāu mau hōʻailona me ka lāʻau wale nō.

ʻAno pinepine ʻo IST i kahi ulia pōpilikia. Hiki i ka 40 pākēneka o ka poʻe i loaʻa kahi IST ke ola ʻole iā ia. Ma muli o nā ʻōuli, hoʻomaka ʻia ka lapaʻau ʻana no ka angina kūpaʻa a i ʻole ka puʻuwai puʻuwai. Hana ʻia ʻo PCI e hoʻāʻo e wehe hou i ke aʻa ke hiki koke a hoʻēmi i ka hōʻino o ka naʻau.

ʻOi aku ka maikaʻi o ka pale ʻana i kahi IST ma mua o ka hoʻāʻo ʻana e mālama iā ia. ʻO ia ke kumu, me kahi aspirin i kēlā me kēia lā no ke ola, loaʻa iā ʻoe i nā mea lahilahi koko ʻē aʻe, e like me clopidogrel (Plavix), prasugrel (Effient), a i ʻole ticagrelor (Brilinta).

Lawe ʻia kēia mau mea lahilahi koko no ka liʻiliʻi o hoʻokahi mahina, akā maʻamau no hoʻokahi makahiki a ʻoi paha, ma hope o ke kau ʻana.

Outlook a me ka pale ʻana i ka restenosis

Ua hana ka ʻenehana o kēia manawa i ka mea liʻiliʻi loa e loaʻa ai iā ʻoe ka restenosis mai ka ulu ʻana o ka mea ma hope o ka angioplasty a i ʻole ke kau stent.

ʻO ka hoʻi mālie o nā ʻōuli i loaʻa iā ʻoe ma mua o ka paʻa mua ʻana o ke aʻa he hōʻailona ia e hana nei i ka restenosis, a pono ʻoe e ʻike i kāu kauka.

ʻAʻole hiki iā ʻoe ke hana he nui e pale ai i ka restenosis ma muli o ka ulu nui ʻana o nā kiko i ka wā o ka hoʻōla. Eia nō naʻe, hiki iā ʻoe ke kōkua i ka pale ʻana i ka restenosis ma muli o ka maʻi coronary artery.

E hoʻāʻo e mālama i kahi ola olakino puʻuwai e hoʻopili ʻole i ka puhipaka, kahi papaʻai olakino, a me ka hoʻoikaika kino. Hiki i kēia ke hoʻohaʻahaʻa i ka makaʻu o ka hoʻoliʻiliʻi plaque i kāu aʻa.

ʻAʻole paha ʻoe e kiʻi IST, keu hoʻi ma hope o kou loaʻa ʻana i kahi stent no hoʻokahi mahina a ʻoi paha. ʻAʻole like me ISR, eia naʻe, koʻikoʻi pinepine ka IST a ke kumu pinepine nei i nā ʻōuli o ka hōʻeha puʻuwai.

ʻO ia ke kumu e pale aku ai i ka IST ma o ka lawe ʻana i nā mea lahilahi o ke koko no ka mea ke koi aku kāu kauka he mea nui loa ia.