Ama-carotids yimithambo ehambisa ubuchopho, intamo nobuso. ICarotid stenosis yisifo esiyinhloko esesabekayo. Ngokuvamile ngokujwayelekile ngeminyaka, kungahle kuholele ekushayweni unhlangothi okudlulayo.

Ubuchopho buhlinzekwa ngemithambo ehlukene: imithambo emibili ye-carotid ngaphambili kanye nemithambo yomgogodla emibili ngemuva. Le mithambo yegazi emine ihlangana ngaphansi kogebhezi ukwakha lokho okubizwa ngokuthi yiPolygon kaWillis.

Okubizwa ngokuthi umthambo oyinhloko noma ovamile we-carotid uvela ku-aorta futhi ukhuphukele entanyeni. Ihlukanisa ezingeni lengxenye ephakathi yentamo ibe imithambo emibili: i-carotid yangaphakathi kanye ne-carotid yangaphandle. Le ndawo yokuhlangana ibizwa ngokuthi i-carotid bifurcation.

Imithambo ye-carotid yangaphakathi inikezela ebuchosheni, kuyilapho imithambo ye-carotid yangaphandle inikezela entanyeni nasebusweni. Ngakho-ke lezi ziyimithambo ebaluleke kakhulu.

I-carotid stenosis iyisilonda esiyinhloko sokwesaba emthanjeni we-carotid.

Kufana nokwehla kobubanzi bomthambo we-carotid, okuvame ukulandela ukwakhiwa koqwembe lwe-atheromatous (ukubekwa kwe-cholesterol, izicubu ezinemicu kanye ne-calcareous) ngaphakathi komthambo. Ezimweni eziningi (90%), le stenosis itholakala ezingeni le-cervical carotid bifurcation.

Ingozi iwukuthi umthambo we-carotid uzogcina uvinjwe i-atheromatous plaque noma uzoqhekeka. Ukuhlasela kwesikhashana kwe-ischemic (TIA) kungase kwenzeke okuhlehlayo ngaphandle kwe-sequelae ngaphansi kwamahora angu-24, noma ingozi ye-cerebrovascular (AVC) noma i-cerebral infarction, ene-sequelae ebucayi kakhulu noma encane.

I-Carotid stenosis ivame ukukhula ngeminyaka: ngokusho kwe-Haute Autorité de Santé, i-5 kuya ku-10% yabantu abangaphezu kweminyaka engama-65 bane-stenosis engaphezu kuka-50%. I-carotid stenosis ilinganiselwa ukuthi ibangela cishe ingxenye yesine yemivimbo.

Ukuphathwa kwe-carotid stenosis kusekelwe ekwelashweni kwezidakamizwa, ukulawulwa kwezici zengozi yemithambo kanye kwezinye iziguli inqubo yokuvuselela kabusha imithambo.

Mayelana nokwelashwa kwezidakamizwa, izinhlobo ezintathu zezidakamizwa zinqunywa ndawonye: i-antiplatelet ejenti yokunciphisa igazi, i-statin ukunciphisa ukwakheka kwama-atheromatous plaque kanye ne-ACE inhibitor (noma i-beta blocker kwezinye izimo).

Ngokuphathelene ne-revascularization, i-French National Authority for Health ikhiphe izincomo ezithile zenkomba yokuhlinzwa ngokuya ngezinga le-carotid stenosis:

• phakathi kuka-70 no-99% we-stenosis, ukuhlinzwa kuboniswa ngenzuzo elinganayo ebalulekile kwabesilisa nabesifazane;
• phakathi kuka-50 no-69% stenosis, ukuhlinzwa kungase kuboniswe kodwa inzuzo incane, ikakhulukazi kwabesifazane;
• phakathi kuka-30 no-49%, ukuhlinzwa akusizi;
• ngaphansi kuka-30%, ukuhlinzwa kuyadabukisa futhi akufanele kwenziwe.

Lapho ukufakwa kabusha kwemithambo kuboniswa, ukuhlinzwa kuhlala kuyindinganiso yegolide. Inqubo, ebizwa nge-carotid endarterectomy, ivame ukwenziwa ngaphansi kwe-anesthesia ejwayelekile. Udokotela ohlinzayo usika intamo, ubopha imithambo emithathu bese usika umthambo we-carotid ezingeni le-stenosis. Ube esusa ngokucophelela uqweqwe lwe-atherosclerotic kanye nemfucumfucu yalo, bese evala umthambo ngocingo oluhle kakhulu.

I-Angioplasty ene-stent ayiboniswa njengokwelashwa komugqa wokuqala. Inikezwa kuphela ezimweni ezithile ezithile zokuphikisana nokuhlinzwa.

Uma une-asymptomatic carotid stenosis:

• ngaphezu kwe-60%: i-revascularization ngokuhlinzwa kwe-carotid ingaboniswa kuye ngezici ezithile (isikhathi sokuphila, ukuqhubeka kwe-stenosis, njll.);
• uma kwenzeka i-stenosis ingaphansi kwama-60%, ukuhlinzwa akuboniswa.

Kanye nokwelashwa kwezidakamizwa nokuhlinzwa, kubalulekile ukuthi ubuyekeze indlela yakho yokuphila ukuze unciphise izici eziyingozi: umfutho wegazi ophakeme, ugwayi, i-hypercholesterolemia nesifo sikashukela.

I-Carotid stenosis ingaba nge-asymptomatic futhi itholakale ngesikhathi sokuhlolwa kwezokwelapha ngudokotela wakho jikelele noma uchwepheshe, noma ngesikhathi se-ultrasound yegilo ngokwesibonelo. Ukuba khona kokububula kwe-carotid ku-auscultation kufanele kuholele ekubhalweni kwe-carotid doppler ultrasound ukuze kuhlolwe ukuthi kungenzeka yini i-carotid stenosis futhi kuhlolwe izinga lokuvinjelwa. Ngokuya ngemiphumela, kuzobekwa i-MRI angiography, i-CT angiography noma i-digital carotid angiography. Kwenza kube nokwenzeka ukunquma indawo, i-morphology kanye nokunwetshwa kwe-plaque, kanye nokuhlola ukusakazeka kwe-atheroma kwamanye ama-ax futhi ikakhulukazi omunye umthambo we-carotid.

Uma kunezimpawu, izimpawu ze-carotid stenosis yilezo zokuhlasela kwesikhashana kwe-ischemic (TIA) nesifo sohlangothi. Noma, kuya ngendawo yobuchopho ethintekile:

• ukulimala kwamehlo (ukulahleka kombono okungazelelwe nokungenabuhlungu kwelinye iso noma i-amaurosis yesikhashana);
• ukukhubazeka ohlangothini olulodwa lomzimba, kungaba okuphelele noma okukhawulelwe esithweni esiphezulu kanye / noma ubuso (i-hemiparesis, ukukhubazeka kobuso);
• ukulahlekelwa ukukhuluma (aphasia).

Ebhekene nalezi zimpawu, kubalulekile ukuxhumana no-15.