Ke noʻonoʻo nei paha ʻoe i ke koʻikoʻi o ka hahau ʻana. ʻO ke kumu nui o kēia, ʻo ke aʻa koʻikoʻi loa (carotid artery) ma nā ʻaoʻao ʻelua o ko kākou ʻāʻī e lawe ana i ke koko i ka lolo ua ālai ʻia e nā waihona momona. Ua like ia me ka ʻōpala e hōʻiliʻili ana i loko o kahi paipu wai a e pani mālie ana iā ia. Akā, mai hopohopo, aia i kēia manawa nā lāʻau lapaʻau holomua a maʻalahi hoʻi no kēia. ʻO ia ka mea a mākou e kamaʻilio nei i kēia lā.
He aha kēia lāʻau i kapa ʻia ʻo TFCAS?
I ka ʻōlelo maʻalahi, ʻo ka Transfemoral Carotid Artery Stenting (TFCAS) kahi hana minimally invasive i hoʻohana ʻia e wehe hou i kahi aʻa carotid i paʻa i ka ʻāʻī. Pili ia i ke kau ʻana i kahi ʻōmole liʻiliʻi e like me ka mesh, i kapa ʻia he stent, i loko o ke aʻa i paʻa e hoʻonui hou iā ia.
E noʻonoʻo e pili ana i ia mea, ʻo nā aʻa carotid ma nā ʻaoʻao ʻelua o ko kākou ʻāʻī nā aʻa nui ʻelua e lawe ana i ka oxygen a me nā meaʻai i ko kākou lolo, ka maka, a me ka ʻāʻī. I ka hala ʻana o ka manawa, hoʻomaka ka cholesterol a me nā momona mai nā meaʻai a kākou e ʻai ai e hōʻiliʻili i loko o nā paia o kēia mau aʻa. Kāhea mākou i kēia plaque. ʻO kēia hōʻiliʻili plaque ke kumu o ka mānoanoa o nā paia o ke aʻa a paʻakikī (atherosclerosis). I ka hopena, lilo nā kīʻaha koko i ʻūlū (stenosis). Ke ālai ʻia kēia kahe koko, emi ka lako koko i ka lolo, e hoʻonui nui ana i ka pilikia o ka hahau ʻana.
I ka mālama ʻana iā TFCAS, hoʻokomo ʻia kahi paipu kūikawā (catheter) ma o kahi ʻoki liʻiliʻi loa ma kou ʻūhā a lima paha a alakaʻi ʻia i ke aʻa i paʻa i kou ʻāʻī. A laila hoʻokomo ʻia kahi stent ma o ke catheter e wehe hou i ke aʻa. ʻO ka stent, e like me ke pou halelewa, kōkua i ka pale ʻana i ke aʻa mai ka hiolo hou ʻana. Hoʻihoʻi kēia i ke kahe koko i ka lolo, e hōʻemi ana i ka pilikia o ka hahau ʻana.
ʻO wai ka mea e pono ai kēia lāʻau lapaʻau?
Hiki ke ʻōlelo ʻia kēia lāʻau lapaʻau inā hoʻoholo kāu kauka he maʻi ʻaʻa carotid kou. I kekahi manawa ʻaʻole paha ʻoe e loaʻa i kekahi mau hōʻailona. Eia nō naʻe, hiki i kekahi poʻe ke ʻike i nā hōʻailona e like me nā mini-strokes (a i ʻole nā hoʻouka kaua ischemic transient - TIAs).
Aia kekahi mau lāʻau lapaʻau no ka stenosis carotid artery. E koho kāu kauka i ka lāʻau lapaʻau kūpono loa iā ʻoe ma muli o kou kūlana olakino, ke ʻano o ke aʻa, a me kahi o ka stenosis.
ʻO ka mea nui loa, ʻo ia ke kūkākūkā me kāu kauka i kahi o kēia mau lāʻau lapaʻau e kūpono loa iā ʻoe.
| ʻAno lapaʻau | ʻO ka mea e hana wale ʻia | Kūikawā |
|---|---|---|
| TFCAS (ke ʻano hana i kūkākūkā ʻia ma kēia ʻatikala) | Ke hoʻokomo ʻana i kahi stent i loko o kahi aʻa koko ma ka ʻāʻī me ka hoʻohana ʻana i kahi paipu i hoʻokomo ʻia ma o ka ʻāʻī a i ʻole ka lima. | ʻAʻohe ʻoki nui. He pōkole ka manawa ho'ōla. |
| ʻO ka Carotid Endarterectomy (CEA) | Hana ʻia kahi ʻoki ma ka ʻāʻī, wehe ʻia ke aʻa, a wehe ʻia ka papa momona (plaque) i hōʻiliʻili ʻia ma laila. | ʻO ke ʻoki kino kuʻuna i hana ʻia ma luna o nā kānaka he nui. |
| ʻO ke kau ʻana o ka Transcarotid Stenting (TCAR) | Hana ʻia kahi ʻoki liʻiliʻi ma ka ʻāʻī ma luna pono o ka iwi ʻāʻī a hoʻokomo pololei ʻia ka stent i loko o ke aʻa. | Ua hōʻike kekahi mau noiʻi he haʻahaʻa kona pilikia o ka hahau ʻana ma mua o TFCAS. |
No wai ka lāʻau lapaʻau TFCAS kūpono loa?
ʻOi aku ka maikaʻi o ka mālama ʻana iā TFCAS nou ma mua o ke ʻoki ʻana iā CEA inā loaʻa iā ʻoe kēia mau mea pilikia:
- Inā ua ālai ʻia ke aʻa ma kahi i hiki ʻole ke hiki maʻalahi ʻia e ke ʻoki kino.
- Inā he mau pilikia olakino ʻē aʻe kāu (comorbidities) e like me ka maʻi puʻuwai, ka maʻi māmā, a i ʻole ka momona.
- Inā he ʻiʻo ʻeha kou ma kou ʻāʻī ma muli o ke ʻoki kino mua a i ʻole ka radiation therapy.
- Inā ua hōʻino ʻia kou mau kaula leo.
Pehea ʻoe e hoʻomākaukau ai ma mua o ke ʻoki kino?
Ma mua o kēia ʻoki kino, e nīnau paha kāu kauka iā ʻoe:
- E hana i kekahi mau hoʻokolohua koko a me nā hoʻokolohua olakino ʻē aʻe.
- E hana i kahi echocardiogram a i ʻole kahi hoʻāʻo koʻikoʻi e nānā i ka hana o ka puʻuwai.
- E hana i kahi hoʻokolohua kiʻi e like me ka `carotid angiography`, `vascular ultrasound`, a i ʻole `MRA` e ʻike pono i kahi i ālai ʻia ai ke aʻa.
- E hāʻawi i kahi papa inoa o nā lāʻau lapaʻau a me nā mea hoʻopihapiha āu e hoʻohana nei.
- Hiki ke kuhikuhi ʻia nā lāʻau lapaʻau e like me ka aspirin e pale ai i nā ʻūpā koko.
- Mai ʻai a inu paha (hoʻokē ʻai) no kekahi mau hola ma mua o ke ʻoki kino.
Pehea e hana ʻia ai ke ʻoki kino? I kēlā me kēia ʻanuʻu
ʻO ka maʻamau, ʻaʻole i ʻoi aku ma mua o ʻelua hola kēia hana ʻoki kino a hana ʻia e kahi hui kauka i hoʻomaʻamaʻa kūikawā ʻia.
| Nā ʻanuʻu | He aha ka mea e hana nei? |
|---|---|
| 1. Hoʻomaʻamaʻa ʻana | E hoʻomaʻemaʻe pinepine ʻia ʻoe. Hiki ke hāʻawi ʻia iā ʻoe kahi lāʻau liʻiliʻi e hōʻoluʻolu iā ʻoe i kou wā e ala ana. |
| 2. Ke hoʻokomo nei i ka catheter | Alakaʻi ʻia kahi paipu kūikawā (catheter) ma o kahi lua liʻiliʻi i hana ʻia ma ka ʻūhā i ke aʻa carotid ma ka ʻāʻī me ke kōkua o nā kukuna X. |
| 3. Ke kau nei i ke kānana | Hoʻokomo ʻia kahi kānana liʻiliʻi ma ʻō aku o ka mea i ālai ʻia e hopu i kekahi palaki e haki paha i ka wā e hoʻonui ʻia ai ke aʻa. Hoʻemi kēia i ka pilikia o ka hahau ʻana. |
| 4. Ke hoʻohana nei i ka pōpō | Hoʻokomo ʻia kahi pōpō liʻiliʻi i loko o ka mea i pani ʻia a hoʻopiha ʻia, kahi e kaomi ai i ka papa momona i ka paia o ke aʻa a hoʻonui i ke aʻa. A laila wehe ʻia ka pōpō. |
| 5. Ke kau ʻana i ka stent | I kēia manawa, ua hoʻokomo ʻia kahi stent hoʻonui ponoʻī i loko o ka ʻāpana i hoʻonui ʻia. Kōkua kēia i ka wehe ʻana o ke aʻa. |
| 6. Hoʻopau ʻana | Hoʻokuʻu ʻia ke kānana a me ke catheter, a ua pani ʻia ka lua ma ka ʻūhā me kahi mea kūikawā. |
He aha ka mea e hana ʻia ma hope o ke ʻoki kino?
Ma hope o ke ʻoki kino, e nānā ʻia ʻoe i loko o kahi lumi hoʻōla no kekahi mau hola. A laila, pono ʻoe e noho ma ka haukapila i ka pō.
- E hāʻawi ʻia iā ʻoe nā lāʻau ʻeha no kekahi ʻeha āu e ʻike ai.
- Na kāu kauka e kuhikuhi iā ʻoe e lawe i nā lāʻau antiplatelet (e.g., Aspirin, Clopidogrel) no ke koena o kou ola e pale aku i nā ʻōpū koko ma kahi o ka stent.
Hiki i ka hapa nui o ka poʻe ke hoʻi i ka home mai ka haukapila ma hope o 24 mau hola. Aia paha he ʻeha, pehu, a me ka ʻeha iki ma kahi i ʻoki ʻia no kekahi mau lā.
He aha nā pōmaikaʻi a me nā pilikia o kēia lāʻau lapaʻau?
Nā Pōmaikaʻi
- Hoʻemi ʻia ka pilikia o ka hahau ʻana: I ka hoʻihoʻi ʻia ʻana o ke kahe o ke koko i ka lolo, ua emi nui ʻia ka pilikia o ka hahau ʻana.
- ʻOki liʻiliʻi: ʻAʻohe ʻoki nui, no laila ua emi ka ʻeha, ka pilikia o ka maʻi, a me ka ʻeha.
- Hoʻōla koke: Hiki iā ʻoe ke hoʻi hou i nā hana maʻamau i loko o kekahi mau lā.
Nā Pōʻino
E like me nā ʻoki kino āpau, aia kahi pilikia liʻiliʻi, akā ʻo ka pilikia o nā pilikia koʻikoʻi ma lalo o 3%.
- Restenosis: I ka manawa pinepine ʻole, hiki ke hana ʻia nā ʻiʻo ʻeha ma lalo o ka stent a hoʻohaiki hou i ke aʻa.
- Hahau: I ka wā o ke ʻoki ʻana, hiki i nā ʻāpana momona ke haki a ālai i kahi aʻa i loko o ka lolo. Eia nō naʻe, ua hoʻemi nui ʻia kēia pilikia e ke kānana a mākou i kūkākūkā ai ma mua.
- Maʻi hohola
- Ke kahe koko a i ʻole ka maʻi
Āhea ʻoe e pono ai e ʻike i ke kauka?
Inā ʻike ʻoe i kekahi o kēia mau hōʻailona ke hoʻi ʻoe i ka home ma hope o ke ʻoki ʻana , e kāhea koke aku i kāu kauka.
- Inā manaʻo ʻoe he kuni a he anu paha
- Inā pau ka nausea a me ka luaʻi
- Inā ʻulaʻula ka wahi ʻoki, pehu, a i ʻole ke kahe ʻana o ka wai melemele (nā hōʻailona o ka maʻi)
ʻO ka mea nui loa: Inā ʻike ʻoe i nā hōʻailona o ka hahau ʻana, e like me ka ʻōlelo ʻole, ka nāwaliwali ma kekahi ʻaoʻao o ke kino, ke kūlou ʻana o ka maka, a i ʻole nā loli o ka ʻike, e hele koke i ka Emergency Department (ETU) o ka haukapila me ka hoʻokaʻulua ʻole.
Leka Lawe-Home
- He kaʻina hana holomua ka TFCAS, he minimally invasive ka mea i hoʻohana ʻia e wehe i nā aʻa i ālai ʻia ma ka ʻāʻī a hōʻemi i ka pilikia o ka hahau ʻana.
- ʻAʻole kūpono kēia lāʻau lapaʻau no nā kānaka a pau. E kūkākūkā me kāu kauka i ke koho lapaʻau kūpono loa iā ʻoe.
- He mea nui loa ka mālama ʻana i kahi nohona olakino (ʻai maikaʻi, hoʻoikaika kino, a me ka hoʻōki ʻana i ka puhipaka) a lawe i kāu mau lāʻau lapaʻau i kuhikuhi ʻia e like me ke kauoha ma hope o ke ʻoki ʻana.
- ʻO ka ʻike ʻana i nā hōʻailona hōʻailona e hiki mai ana ma hope o ke ʻoki ʻana, a ʻoi aku hoʻi nā hōʻailona o ka hahau ʻana, hiki ke kōkua i ka hoʻopakele ʻana i kou ola.
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