Angioplasty ati gbigbe ipo - iṣan carotid

Awọn ohun elo ẹjẹ ti o mu ẹjẹ wa si ọpọlọ rẹ ati oju ni a pe ni awọn iṣọn-ara carotid. O ni iṣọn-ẹjẹ carotid ni ẹgbẹ kọọkan ti ọrùn rẹ.

Ṣiṣan ẹjẹ ninu iṣọn ara yii le di apakan tabi dina patapata nipasẹ ohun elo ọra ti a pe ni okuta iranti. Idinku apakan ni a npe ni stenosis iṣọn-ẹjẹ carotid (dín). Idena ninu iṣan carotid rẹ le dinku ipese ẹjẹ si ọpọlọ rẹ. Nigbakan apakan apakan ti okuta iranti le fọ ki o dẹkun iṣan miiran. Ọpọlọ le waye ti ọpọlọ rẹ ko ba gba ẹjẹ to.

Awọn ilana meji ni a le lo lati tọju iṣọn-ẹjẹ carotid ti o dín tabi dina. Iwọnyi ni:

• Isẹ abẹ lati yọ buildup okuta iranti (endarterectomy)
• Carotid angioplasty pẹlu ifipamọ stent

Carotid angioplasty ati stenting (CAS) ni a ṣe nipa lilo gige abẹ kekere kan.

• Dọkita abẹ rẹ yoo ṣe abẹ abẹ ni itan-ara rẹ lẹhin lilo diẹ ninu oogun ti npa. A o tun fun ọ ni oogun lati sinmi rẹ.
• Onisegun naa gbe katasi kan (tube to rọ) nipasẹ gige sinu iṣan ara. O ti farabalẹ gbe soke si ọrun rẹ si idena ninu iṣọn-ẹjẹ carotid rẹ. Gbigbe awọn aworan x-ray (fluoroscopy) ni a lo lati wo iṣọn-ẹjẹ ati itọsọna catheter si ipo ti o tọ.
• Nigbamii ti, oniṣẹ abẹ yoo gbe okun waya kan kọja nipasẹ catheter si idena naa. Kateja miiran pẹlu kekere alafẹfẹ kekere kan lori opin ni yoo ti lori okun waya yii ati sinu idiwọ naa. Lẹhinna a ti fun baluu naa.
• Baluu naa n tẹ lodi si ogiri inu ti iṣan rẹ. Eyi ṣii iṣọn-ẹjẹ ati gba ẹjẹ diẹ sii lati ṣàn si ọpọlọ rẹ. O tun le gbe stent kan (tube apapo apapo) ni agbegbe ti a ti dina. Ti fi sii stent ni akoko kanna bi catheter balloon. O gbooro pẹlu alafẹfẹ. O fi aaye silẹ ni aaye lati ṣe iranlọwọ lati jẹ ki iṣọn-ọkan ṣii.
• Dọkita abẹ lẹhinna yọ baluu naa kuro.

Iṣẹ abẹ Carotid (endarterectomy) jẹ ọna ti o dagba ati ti o munadoko lati tọju awọn iṣọn ti o dín tabi dina. Ilana yii jẹ ailewu pupọ.

CAS ti dagbasoke bi yiyan ti o dara si iṣẹ abẹ, nigbati o ba ṣe nipasẹ awọn oniṣẹ ti o ni iriri. Awọn ifosiwewe kan le ṣojuuṣe diduro, gẹgẹbi:

• Eniyan naa ṣaisan pupọ lati ni itọju endometerectomy carotid.
• Ipo ti isunku ninu iṣan carotid jẹ ki iṣẹ abẹ le.
• Eniyan naa ti ni ọrun tabi iṣẹ abẹ carotid ni igba atijọ.
• Eniyan naa ti ni eegun si ọrun.

Awọn eewu ti carotid angioplasty ati ipo ifunni, eyiti o dale lori awọn ifosiwewe bii ọjọ-ori, ni:

• Ẹhun ti ara korira
• Awọn didi ẹjẹ tabi ẹjẹ ni aaye ti iṣẹ abẹ
• Ibajẹ ọpọlọ
• Clogging ti inu ti stent (in-stent restenosis)
• Arun okan
• Ikuna kidirin (eewu ti o ga julọ ninu awọn eniyan ti o ni awọn iṣoro akọọlẹ tẹlẹ)
• Ikun diẹ sii ti iṣan carotid lori akoko
• Awọn ijagba (eyi jẹ toje)
• Ọpọlọ

Olupese ilera rẹ yoo ṣe idanwo ti ara ati ṣe awọn idanwo iṣoogun pupọ.

Nigbagbogbo sọ fun olupese rẹ kini awọn oogun ti o mu, pẹlu awọn oogun, awọn afikun, tabi ewe ti o ra laisi iwe-aṣẹ.

Lakoko awọn ọsẹ 2 ṣaaju ilana rẹ:

• Awọn ọjọ ṣaaju iṣẹ-abẹ, o le ni lati da gbigba awọn oogun ti o jẹ ki o nira fun ẹjẹ rẹ lati di. Iwọnyi pẹlu aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), ticagrelor (Brilinta), prasugrel (Effient) naprosyn (Aleve, Naproxen), ati awọn oogun miiran bii iwọnyi.
• Beere lọwọ olupese rẹ awọn oogun wo ni o tun gbọdọ mu ni ọjọ iṣẹ abẹ rẹ.
• Ti o ba mu siga, o nilo lati da. Beere lọwọ olupese rẹ fun iranlọwọ fifun.
• Nigbagbogbo jẹ ki olupese rẹ mọ nipa eyikeyi otutu, aisan, iba, breakout herpes, tabi aisan miiran ti o le ni ṣaaju iṣẹ-abẹ rẹ.

MAA ṢE mu ohunkohun lẹhin ọganjọ alẹ alẹ ṣaaju iṣẹ abẹ rẹ, pẹlu omi.

Ni ọjọ iṣẹ abẹ rẹ:

• Mu awọn oogun ti a ti sọ fun ọ lati mu pẹlu omi kekere.
• A yoo sọ fun ọ nigbati o yoo de ile-iwosan.

Lẹhin iṣẹ-abẹ, o le nilo lati duro ni ile-iwosan ni alẹ ki o le wo fun awọn ami eyikeyi ti ẹjẹ, ikọlu, tabi ṣiṣan ẹjẹ ti ko dara si ọpọlọ rẹ.O le ni anfani lati lọ si ile ni ọjọ kanna ti ilana rẹ ba ṣe ni kutukutu ọjọ ati pe o n ṣe daradara. Olupese rẹ yoo ba ọ sọrọ nipa bi o ṣe le ṣe abojuto ara rẹ ni ile.

Carotid artery angioplasty ati stenting le ṣe iranlọwọ lati dinku aye rẹ ti nini ikọlu. Ṣugbọn iwọ yoo nilo lati ṣe awọn ayipada igbesi aye lati ṣe iranlọwọ lati ṣe idibajẹ okuta iranti, didi ẹjẹ, ati awọn iṣoro miiran ninu awọn iṣọn carotid rẹ ju akoko lọ. O le nilo lati yi ounjẹ rẹ pada ki o bẹrẹ eto adaṣe ti olupese rẹ ba sọ fun ọ pe adaṣe jẹ ailewu fun ọ.

Carotid angioplasty ati stenting; CAS; Angioplasty - iṣan carotid; Stenosis iṣọn-ẹjẹ Carotid - angioplasty

• Angina - yosita
• Angina - kini lati beere lọwọ dokita rẹ
• Angina - nigbati o ba ni irora àyà
• Angioplasty ati stent - okan - yosita
• Awọn oogun Antiplatelet - Awọn onidena P2Y12
• Aspirin ati aisan okan
• Bọtini, margarine, ati awọn epo sise
• Cholesterol ati igbesi aye
• Cholesterol - itọju oogun
• Ṣiṣakoso titẹ ẹjẹ giga rẹ
• Awọn alaye ounjẹ ti a ṣalaye
• Yara awọn italolobo
• Ikun okan - yosita
• Ikọlu ọkan - kini lati beere lọwọ dokita rẹ
• Arun ọkan-ọkan - awọn okunfa eewu
• Bii o ṣe le ka awọn akole ounjẹ
• Iyọ-iyọ kekere
• Onje Mẹditarenia
• Abojuto itọju ọgbẹ - ṣii

• Atherosclerosis ti iṣan carotid inu
• Carotid stenosis - X-ray ti iṣan to tọ
• Awọn olupilẹṣẹ idaabobo awọ

Aboyans V, Ricco JB, Bartelink MEL, et al. Aṣayan Olootu - Awọn ilana 2017 ESC lori ayẹwo ati itọju awọn arun inu ọkan, ni ifowosowopo pẹlu European Society for Surgery Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018; 55 (3): 305-368. PMID: 28851596 pubmed.ncbi.nlm.nih.gov/28851596/.

Brott TG, Halperin JL, Abbara S, et al. 2011 ASA / ACCF / AHA / AANN / AANS / ACR / ASNR / CNS / SAIP / SCAI / SIR / SNIS / SVM / SVS itọnisọna lori iṣakoso ti awọn alaisan pẹlu extracranial carotid ati iṣọn-ẹjẹ iṣọn-ara iṣan: akopọ alaṣẹ: ijabọ ti Amẹrika College of Cardiology Foundation / American Heart Association Task Force on Didaṣe Awọn ilana, ati American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Aworan ati Idena, Awujọ fun Ẹkọ nipa iṣan ara ati awọn ilowosi, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, ati Awujọ fun Isẹgun iṣan. Ti dagbasoke ni ifowosowopo pẹlu Ile-ẹkọ giga ti Amẹrika ti Neurology ati Society of Cardomovascular Computed Tomography. Catheter Cardiovasc Interv. 2013; 81 (1): E76-E123. PMID: 23281092 pubmed.ncbi.nlm.nih.gov/23281092/.

Brott TG, Howard G, Roubin GS, et al. Awọn abajade igba pipẹ ti stenting dipo endarterectomy fun stenosis carotid-artery. N Engl J Med. 2016; 374 (11): 1021-1031. PMID: 26890472 pubmed.ncbi.nlm.nih.gov/26890472/.

Hicks CW, Malas MB. Arun Cerebrovascular: stenting iṣọn ẹjẹ carotid. Ni: Sidawy AN, Perler BA, eds. Iṣẹ abẹ ti iṣan ti Rutherford ati Itọju Endovascular. 9th ed. Philadelphia, PA: Elsevier; 2019: ori 92.

Kinlay S, Bhatt DL. Itoju ti aiṣedede ti iṣan ti iṣan ti iṣan. Ni: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Arun Okan ti Braunwald: Iwe-kika ti Oogun Ẹkọ inu ọkan ati ẹjẹ. 11th ed. Philadelphia, PA: Elsevier; 2019: ori 66.

Rosenfield K, Matsumura JS, Chaturvedi S, et al. Iwadii laileto ti stent dipo iṣẹ abẹ fun stenosis carotid asymptomatic. N Engl J Med. 2016; 374 (11): 1011-1020. PMID: 26886419 pubmed.ncbi.nlm.nih.gov/26886419/.