Carotid ndi mitsempha yomwe imapereka ubongo, khosi ndi nkhope. Carotid stenosis ndiye vuto lalikulu lomwe liyenera kuopedwa. Zofala kwambiri ndi zaka, zimatha kapena sizingayambitse sitiroko yosakhalitsa.

Ubongo umaperekedwa ndi mitsempha yosiyana siyana: mitsempha iwiri ya carotid kutsogolo ndi mitsempha iwiri ya vertebral kumbuyo. Mitsempha inayi imeneyi imakumana m’munsi mwa chigazacho n’kupanga chotchedwa Polygon of Willis.

Zomwe zimatchedwa mtsempha wapakati kapena wamba wa carotid umachokera ku aorta ndikukwera pakhosi. Amagawaniza pamlingo wapakati pa khosi kukhala mitsempha iwiri: carotid yamkati ndi carotid yakunja. Malo ophatikizikawa amatchedwa carotid bifurcation.

Mitsempha yamkati ya carotid imapereka ku ubongo, pamene mitsempha yakunja ya carotid imapereka ku khosi ndi kumaso. Choncho iyi ndi mitsempha yofunika kwambiri.

Carotid stenosis ndiye chotupa chachikulu cha mantha mu mitsempha ya carotid.

Zimafanana ndi kuchepa kwakuya kwa mtsempha wa carotid, nthawi zambiri kutsata mapangidwe a atheromatous plaque (kuyika kwa cholesterol, fibrous ndi calcareous tissues) mkati mwa mtsempha wamagazi. Nthawi zambiri (90%), stenosis iyi imapezeka pamlingo wa khomo lachiberekero la carotid bifurcation.

Choopsa chake ndi chakuti mtsempha wa carotid umatha kutsekedwa ndi cholembera cha atheromatous kapena kuti udzagawanika. A transient ischemic attack (TIA) atha kuchitika omwe amabwerera popanda sequelae pasanathe maola 24, kapena ngozi ya cerebrovascular (AVC) kapena cerebral infarction, yokhala ndi zotsatira zovuta kwambiri.

Carotid stenosis ndi yofala ndi zaka: malinga ndi Haute Autorité de Santé, 5 mpaka 10% mwa anthu oposa 65 ali ndi stenosis yoposa 50%. Carotid stenosis akuti imayambitsa pafupifupi kotala la sitiroko.

Ulamuliro wa carotid stenosis umachokera ku chithandizo chamankhwala, kuwongolera zoopsa za mitsempha komanso kwa odwala ena njira ya revascularization.

Pankhani ya chithandizo chamankhwala, mitundu itatu ya mankhwala imayikidwa pamodzi: antiplatelet wothandizira kuti magazi azichepa, statin kuti achepetse kukula kwa atheromatous plaques ndi ACE inhibitor (kapena beta blocker nthawi zina).

Pankhani ya revascularization, French National Authority for Health yapereka malingaliro achindunji owonetsa opaleshoni molingana ndi kuchuluka kwa symptomatic carotid stenosis:

• pakati pa 70 ndi 99% ya stenosis, opaleshoni imasonyezedwa ndi phindu lofanana ndi amuna ndi akazi;
• pakati pa 50 ndi 69% stenosis, opaleshoni ikhoza kuwonetsedwa koma phindu ndilochepa, makamaka kwa amayi;
• pakati pa 30 ndi 49%, opaleshoni sizothandiza;
• pansi pa 30%, opaleshoniyo ndi yowononga ndipo sayenera kuchitidwa.

Pamene revascularization ikuwonetsedwa, opaleshoni imakhalabe muyezo wagolide. Njirayi, yotchedwa carotid endarterectomy, nthawi zambiri imachitidwa pansi pa anesthesia wamba. Dokotala wa opaleshoni amadula khosi, amamangirira mitsempha itatuyo ndiyeno amadula mtsempha wa carotid pamlingo wa stenosis. Kenako amachotsa mosamala cholembera cha atherosclerotic ndi zinyalala zake, kenako amatseka mtsempha wamagazi ndi waya wabwino kwambiri.

Angioplasty yokhala ndi stent sikuwonetsedwa ngati chithandizo choyambirira. Amangoperekedwa muzochitika zina za contraindication kwa opaleshoni.

Ngati asymptomatic carotid stenosis:

• opitilira 60%: revascularization ndi opaleshoni ya carotid imatha kuwonetsedwa kutengera zinthu zina (nthawi ya moyo, kupitilira kwa stenosis, etc.);
• ngati stenosis zosakwana 60%, opaleshoni si anasonyeza.

Pamodzi ndi mankhwala ndi mankhwala opangira opaleshoni, ndikofunikira kuyang'anitsitsa moyo wanu kuti muchepetse chiopsezo: kuthamanga kwa magazi, fodya, hypercholesterolemia ndi shuga.

Carotid stenosis imatha kukhala yopanda zizindikiro ndipo imapezeka pakuyezetsa kwachipatala ndi dokotala wanu wamkulu kapena katswiri, kapena panthawi ya ultrasound ya chithokomiro. Kukhalapo kwa kung'ung'udza kwa carotid pa auscultation kuyenera kutsogolere kumankhwala a carotid doppler ultrasound kuti azindikire zotheka carotid stenosis ndikuwunika kuchuluka kwa kutsekeka. Kutengera ndi zotsatira, MRI angiography, CT angiography kapena digito carotid angiography idzayikidwa. Zimapangitsa kudziwa komwe kuli, morphology ndi kufalikira kwa chipikacho, ndikuwunika kufalikira kwa atheroma pa nkhwangwa zina komanso makamaka mtsempha wina wa carotid.

Pamene zizindikiro, zizindikiro za carotid stenosis ndi za transient ischemic attack (TIA) ndi sitiroko. Kaya, kutengera dera la ubongo lomwe lakhudzidwa:

• kuwonongeka kwa diso (kutayika kwadzidzidzi komanso kosapweteka kwa masomphenya m'diso limodzi kapena amaurosis yosakhalitsa);
• ziwalo mbali imodzi ya thupi, zonse kapena zochepa kumtunda ndi / kapena nkhope (hemiparesis, ziwalo za nkhope);
• kutaya mawu (aphasia).

Mukakumana ndi zizindikiro izi, ndikofunikira kulumikizana ndi 15.