ʻO nā carotid nā aʻa e hāʻawi ana i ka lolo, ka ʻāʻī a me ka maka. ʻO Carotid stenosis ka maʻi maʻi nui e makaʻu ʻia. He mea maʻamau i ka makahiki, hiki a ʻaʻole paha ke alakaʻi i kahi hahau transient.

Hāʻawi ʻia ka lolo e nā ʻaʻaʻa like ʻole: ʻelua aʻa carotid i mua a ʻelua aʻaʻa vertebral ma hope. Hui kēia mau ʻaʻaʻa ʻehā ma ke kumu o ka iwi poʻo i kapa ʻia ʻo ka Polygon of Willis.

ʻO ka mea i kapa ʻia ʻo ke kumu mua a i ʻole ka maʻamau carotid artery e kū mai ana mai ke aorta a piʻi i ka ʻāʻī. Hoʻokaʻawale ia ma ke kiʻekiʻe o ka ʻāpana waena o ka ʻāʻī i ʻelua aʻa: ka carotid kūloko a me ka carotid waho. Kapa ʻia kēia ʻāpana hui ʻana i ka carotid bifurcation.

Hāʻawi nā ʻaʻaʻa carotid kūloko i ka lolo, a ʻo nā aʻa carotid waho e hāʻawi i ka ʻāʻī a me ka maka. No laila, he mau aʻa koʻikoʻi kēia.

ʻO Carotid stenosis ka maʻi nui e makaʻu ai i ke aʻa carotid.

Hoʻohālikelike ia me ka emi ʻana o ke anawaena o ke aʻa carotid, ʻoi loa ma hope o ka hoʻokumu ʻia ʻana o kahi plaque atheromatous (deposition o cholesterol, fibrous a me calcareous tissues) i loko o ke aʻa. I ka hapa nui o nā hihia (90%), ʻike ʻia kēia stenosis ma ka pae o ka bifurcation carotid cervical.

ʻO ka pilikia ʻo ia ka pau ʻana o ke aʻa carotid i ka paʻa ʻia e ka atheromatous plaque a i ʻole e ʻāpana. A laila hiki ke loaʻa kahi hōʻeha ischemic transient (TIA) e hoʻi hou ana me ka ʻole o ka hopena ma lalo o 24 mau hola, a i ʻole he ulia cerebrovascular (AVC) a i ʻole ka cerebral infarction, me nā sequelae koʻikoʻi a i ʻole.

He mea maʻamau ka stenosis Carotid me ka makahiki: e like me ka Haute Autorité de Santé, 5 a 10% o ka poʻe ma luna o 65 ka nui o ka stenosis ma mua o 50%. Ua manaʻo ʻia ʻo Carotid stenosis ke kuleana no kahi hapaha o nā hahau.

Hoʻokumu ʻia ka mālama ʻana o ka carotid stenosis ma ka mālama ʻana i ka lāʻau lapaʻau, ka mālama ʻana i nā mea pilikia vascular a no kekahi mau mea maʻi kahi kaʻina hana revascularization.

E pili ana i ka lāʻau lapaʻau, ʻekolu ʻano lāʻau i kuhikuhi pū ʻia: he antiplatelet agent e hoʻokaʻawale i ke koko, kahi statin e kaupalena i ka hoʻomohala ʻana o nā plaque atheromatous a me kahi inhibitor ACE (a i ʻole beta blocker i kekahi mau hihia).

E pili ana i ka revascularization, ua hoʻopuka ka French National Authority for Health i nā ʻōlelo aʻoaʻo kūikawā no ka hōʻike ʻana i ke kaʻina e like me ke kiʻekiʻe o ka symptomatic carotid stenosis:

• ma waena o 70 a me 99% o ka stenosis, hōʻike ʻia ke ʻoki ʻana me kahi pōmaikaʻi nui like i nā kāne a me nā wahine;
• ma waena o 50 a me 69% stenosis, hiki ke hōʻike ʻia ke ʻoki ʻana akā ʻoi aku ka liʻiliʻi o ka pōmaikaʻi, ʻoi loa i nā wahine;
• ma waena o 30 a me 49%, ʻaʻole pono ke ʻoki;
• ma lalo o 30%, he deleterious ke kaʻina hana a ʻaʻole pono e hana ʻia.

Ke hōʻike ʻia ka revascularization, hoʻomau ka ʻokiʻoki i ke kūlana gula. ʻO ke kaʻina hana, i kapa ʻia ʻo carotid endarterectomy, hana pinepine ʻia ma lalo o ka anesthesia maʻamau. Hana ke kauka lapaʻau i kahi ʻoki ma ka ʻāʻī, hoʻopaʻa i nā aʻaʻa ʻekolu a laila ʻoki i ke aʻa carotid ma ke kiʻekiʻe o ka stenosis. A laila wehe pono ʻo ia i ka plaque atherosclerotic a me kāna ʻōpala, a laila pani i ke aʻa me kahi uea maikaʻi loa.

ʻAʻole hōʻike ʻia ka Angioplasty me kahi stent ma ke ʻano he lāʻau lapaʻau mua. Hāʻawi wale ʻia ia i kekahi mau hihia kikoʻī o ka contraindication i ke ʻoki.

I ka hihia o ka asymptomatic carotid stenosis:

• ʻoi aku ka nui ma mua o 60%: hiki ke hōʻike ʻia ka revascularization e ka ʻoki carotid ma muli o kekahi mau kumu (ke ola ola, ka holomua o ka stenosis, etc.);
• i ka hihia o ka stenosis ma lalo o 60%, ʻaʻole hōʻike ʻia ke ʻoki.

Me ka lāʻau lapaʻau a me ka hoʻomaʻamaʻa ʻana, pono ia e nānā i kou nohona e kaupalena i nā kumu pilikia: ke koko kiʻekiʻe, ka paka, hypercholesterolemia a me ka maʻi diabetes.

Hiki i ka carotid stenosis ke asymptomatic a ʻike ʻia i ka wā o ka hoʻokolokolo lāʻau e kāu kauka lapaʻau a loea paha, a i ʻole i ka ultrasound o ka thyroid. ʻO ka loaʻa ʻana o kahi ʻōhumu carotid ma ka auscultation pono e alakaʻi i ka ʻōlelo ʻana o kahi carotid doppler ultrasound e ʻike ai i kahi carotid stenosis a loiloi i ka nui o ke keakea. Ma muli o nā hopena, e kuhikuhi ʻia ka MRI angiography, CT angiography a i ʻole carotid angiography. Hiki iā ia ke hoʻoholo i ka wahi, morphology a me ka hoʻonui ʻana o ka plaque, a me ka nānā ʻana i ka laha ʻana o ka atheroma ma nā koʻi ʻē aʻe a me ke ʻano o ke aʻa carotid ʻē aʻe.

Ke hōʻailona ʻia, ʻo nā hōʻailona o ka carotid stenosis ʻo ia ka transient ischemic attack (TIA) a me ka hahau. Ma muli o ka wahi o ka lolo i hoʻopilikia ʻia:

• ka poino o ka maka (ka nalo koke a me ka eha ole o ka ike ma ka maka hookahi a i ole amaurosis transient);
• maʻi maʻi ma kekahi ʻaoʻao o ke kino, i ka huina a i kaupalena ʻia i ka lālā luna a me / a i ʻole ka maka (hemiparesis, facial paralysis);
• nalowale o ka olelo (aphasia).

I mua o kēia mau hōʻailona, ​​​​pono e hoʻopili iā 15.