Ibihombo By'Amaraso By'Igihe Gito (Tia)

Ibihombo by'amaraso mu bwonko (TIA) ni igihe gito cy'ibimenyetso bisa n'iby'umuvuduko w'amaraso mu bwonko. Bitewe no kubura amaraso mu bwonko igihe gito. TIA isanzwe imara iminota mike gusa kandi ntiterwa ibibazo by'igihe kirekire.

Ariko, TIA ishobora kuba ikimenyetso. Abantu bagera kuri 1/3 bafite TIA baza kugira umuvuduko w'amaraso mu bwonko, hafi kimwe cya kabiri bibaho mu mwaka umwe nyuma ya TIA.

Akenshi bita ministroke, TIA ishobora kuba ikimenyetso cy'umuvuduko w'amaraso mu bwonko mu gihe kizaza ndetse n'amahirwe yo kubikumira.

Ibitero by'uburwayi bw'agateganyo (TIA) bisanzwe biba iminota mike. Ibimenyetso byinshi biracika mu gihe kitarenze isaha imwe. Gake cyane, ibimenyetso bishobora kumara amasaha 24. Ibimenyetso bya TIA bisa n'ibimenyetso biboneka mu ntangiriro z'umuvuduko w'amaraso mu bwonko. Ibimenyetso bigaragara mu buryo butunguranye kandi bishobora kuba birimo:

• Kugira intege nke, kubabara cyangwa uburibwe mu maso, ukuboko cyangwa ukuguru, ahanini ku ruhande rumwe rw'umubiri.
• Kutabona neza cyangwa kugira ikibazo cyo kumva abandi.
• Ubuhumyi mu jisho rimwe cyangwa mu yombi cyangwa kubona ibintu bibiri.
• Kuzenguruka cyangwa kubura ubushobozi bwo kubungabunga umubiri cyangwa guhuza ibikorwa.

Ushobora kugira TIA zirenze imwe. Ibimenyetso byazo bishobora kuba bisa cyangwa bitandukanye bitewe n'agace k'ubwonko kagizwemo ingaruka.

Niba utekereza ko ufite cyangwa wari ufite ikibazo cy'uburwayi bw'ubwonko (TIA), shaka ubufasha bw'abaganga ako kanya. TIA kenshi iba mbere y'igituntu cy'ubwonko amasaha cyangwa iminsi. Kwisuzumisha vuba bivuze ko abaganga bashobora kumenya indwara zishobora kuvurwa. Kuvura izo ndwara bishobora kugufasha kwirinda igituntu cy'ubwonko.

Impamvu itera ikibazo cy'imikorere y'ubwonko gihita gikira (transient ischemic attack) isa n'impamvu itera ikibazo cyo kubura amaraso mu bwonko (ischemic stroke), ari cyo kibazo cyo kubura amaraso mu bwonko gikunze kugaragara. Mu kibazo cyo kubura amaraso mu bwonko, umuvuduko w'amaraso urafunga inzira y'amaraso yerekeza ku gice cy'ubwonko. Mu kibazo cy'imikorere y'ubwonko gihita gikira, bitandukanye n'ikibazo cyo kubura amaraso mu bwonko, inzira ifunzwe iba igihe gito kandi nta kibazo kirambye kibaho.

Urufunge ruba mu gihe cy'ikibazo cy'imikorere y'ubwonko gihita gikira rukunze guterwa n'umunyu wa kolesterol hamwe n'amasukari yitwa plaques mu mubiri w'imitsi. Ibi bizwi nka atherosclerosis. Ibi kandi bishobora kuba mu mubiri w'imitsi itanga ogisijeni n'ibindi by'ingenzi ku bwonko.

Plaques zishobora kugabanya umuvuduko w'amaraso unyura mu mubiri w'imitsi cyangwa zigatuma habaho umuvuduko w'amaraso urafunze. Umuvuduko w'amaraso uvuye ahandi mu mubiri, urugero nk'umutima, ujya mu mubiri w'imitsi utanga amaraso ku bwonko nawo ushobora guteza ikibazo cy'imikorere y'ubwonko gihita gikira.

Bimwe mu bintu byongera ibyago byo kugira ikibazo cy'ubwonko cy'igihe gito (TIA) n'igicuri ntabwo bishobora guhinduka. Ibindi ushobora kubigenzura.Ntabwo ushobora guhindura ibi bintu byongera ibyago bya TIA n'igicuri. Ariko kumenya ko ufite ibyo byago bishobora kukugira ishyaka ryo guhindura ibyo byago ushobora kugenzura.

• Amateka y'umuryango. Ibyago byawe bishobora kuba byinshi niba umwe mu bagize umuryango wawe yigeze kugira TIA cyangwa igicuri.
• Imyaka. Ibyago byawe byiyongera uko ugenda ukura, cyane cyane nyuma y'imyaka 55.
• Ibitsina. Abagabo bafite ibyago byinshi gato byo kugira TIA n'igicuri. Ariko uko abagore bagenda bakura, ibyago byabo byo kugira igicuri byiyongera.
• Ikibazo cy'ubwonko cy'igihe gito cyabanje. Niba warigeze kugira TIA imwe cyangwa nyinshi, ufite ibyago byinshi byo kugira igicuri.
• Indwara ya sickle cell. Igicuri ni ikibazo gikunze kubaho kubera indwara ya sickle cell, izwi kandi nka anemia ya sickle cell. Udukundi tw'amaraso dufite ishusho ya sickle dutwara ogisijeni nke kandi tugenda dufatwa mu bice by'imitsi, bigatuma amaraso atagera mu bwonko. Ariko, ukoresheje ubuvuzi bukwiye bw'indwara ya sickle cell, ushobora kugabanya ibyago byo kugira igicuri.

Ushobora kugenzura cyangwa kuvura ibintu byinshi byongera ibyago bya TIA n'igicuri, birimo ibibazo bimwe by'ubuzima n'imikorere y'ubuzima. Kugira kimwe cyangwa byinshi muri ibyo bintu ntibisobanura ko uzagira igicuri, ariko ibyago byawe byiyongera niba ufite bibiri cyangwa byinshi muri byo.

• Kolesterol nyinshi. Kurya kolesterol n'ibinure bike, cyane cyane ibinure bisatura kandi ibinure bya trans, bishobora kugabanya ibibyimba biri mu mitsi yawe. Niba udashobora kugenzura kolesterol yawe ukoresheje impinduka mu mirire gusa, umuvuzi wawe ashobora kwandika imiti igabanya kolesterol cyangwa indi miti.
• Indwara z'umutima. Ibi birimo gucika intege kw'umutima, ikibazo cy'umutima, kwandura kw'umutima cyangwa ikibazo cy'umutima.
• Indwara y'imitsi ya carotid. Muri iyi ndwara, imitsi y'amaraso iri mu ijosi igana mu bwonko irafunikwa.
• Indwara y'imitsi y'amaraso yo ku ruhande (PAD). PAD itera imitsi y'amaraso itwara amaraso mu maboko n'amaguru gufunikwa.
• Diabete. Diabete ihuta kandi ikomeza kugabanya imitsi kubera ubwinshi bw'ibinure, bizwi nka atherosclerosis.
• Ubwinshi bw'homocysteine. Ubwinshi bw'iyi amino acide mu maraso bushobora gutera imitsi kuba myiza no gukomera. Ibi bituma byoroshye gukora imikaya.
• Umurire urengeje urugero. Gutakaza ibiro, cyane cyane gutwara ibiro byinshi mu nda, byongera ibyago byo kugira igicuri.
• COVID-19. Hari ibimenyetso bigaragaza ko virusi itera COVID-19 ishobora kongera ibyago byo kugira igicuri.
• Ubunebwe. Gukora imyitozo ngororamubiri yoroshye iminota 30 buri munsi bifasha kugabanya ibyago.
• Imirire mibi. Kurya ibinure n'umunyu bike bigabanya ibyago bya TIA n'igicuri.
• Kunywesha inzoga nyinshi. Niba unywa inzoga, wirinde kunywa inzoga zirenze imwe ku bagore n'inzoga ebyiri ku bagabo ku munsi.
• Koresha ibiyobyabwenge bitemewe. Irinde cocaine n'ibindi biyobyabwenge bitemewe.

Kumenya ibyago byawe no kubaho neza ni byo bintu byiza ushobora gukora kugira ngo wirinde ikibazo cy'uburwayi bwa transiente ischemic. Ubuzima buzira umuze burimo kujya kwa muganga gukorerwa isuzuma buri gihe. Nanone:

• Ntukamene. Kureka kunywa itabi bigabanya ibyago byo kugira TIA cyangwa umuvuduko w'amaraso.
• Gabanya cholesterol na fat. Kugabanya cholesterol na fat, cyane cyane saturated fat na trans fat, mu byo urya bishobora kugabanya ubwinshi bw'ibintu bimeze nk'amabuye mu mitsi y'amaraso.
• Funga imbuto n'imboga nyinshi. Ibi biribwa birimo intungamubiri nka potasiyumu, folate na antioxydants, bishobora kurinda TIA cyangwa umuvuduko w'amaraso.
• Gabanya kunywa inzoga. Nywa inzoga mu rugero, niba ari byo. Urugero rusabwa ni inzoga imwe gusa ku bagore buri munsi na ebyiri ku bagabo buri munsi.
• Ntukore ibiyobyabwenge bitemewe. Ibiyobyabwenge bitemewe nka cocaine bifitanye isano n'ibyago byiyongereye byo kugira TIA cyangwa umuvuduko w'amaraso.

Gusuzumwa vuba bw’ibimenyetso byawe ni ingenzi mu kumenya icyateye ikibazo cy’uburwayi bwa ischemic buhoraho. Bifasha kandi umuganga wawe kumenya uko yakwitaho neza. Kugira ngo amenye icyateye TIA kandi asuzume ibyago byo kurwara umwijima, umuganga wawe ashobora kwifashisha ibi bikurikira:

• Ubuvuzi bw’amajwi bwa carotid. Niba umuganga wawe akeka ko umuyoboro wa carotid mu ijosi ushobora kuba ari wo watumye urwara TIA, ushobora gukenera ubuvuzi bw’amajwi bwa carotid. Igikoresho gisa n’inkoni kitwa transducer kirungika amajwi y’umuvuduko mwinshi mu ijosi. Ayo majwi anyura mu mubiri maze akora amashusho ku idirishya. Ayo mashusho ashobora kwerekana imiyoboro ya carotid yagabanutse cyangwa hari ikintu kiyikingiye.
• Ubuvuzi bw’amashusho ya mudasobwa (CT) cyangwa ubuvuzi bw’amashusho ya mudasobwa ya angiography (CTA). Ubuvuzi bwa CT bw’umutwe bukoresha imirasire ya X-ray kugira ngo bukore ishusho ya 3D. Ibi bituma umuganga wawe ashobora kureba ubwonko cyangwa imiyoboro y’amaraso mu ijosi no mu bwonko. Ubuvuzi bwa CTA bushobora gukubiyemo gutera umuti ugaragara mu mubiri mu muyoboro w’amaraso. Bitandukanye n’ubuvuzi bw’amajwi bwa carotid, ubuvuzi bwa CTA bushobora kureba imiyoboro y’amaraso mu ijosi no mu mutwe.
• Ubuvuzi bw’amashusho ya magnétique (MRI) cyangwa ubuvuzi bw’amashusho ya magnétique ya angiography (MRA). Ibi bipimo bikoresha ikirere gikomeye cya magnétique kugira ngo bikore ishusho ya 3D y’ubwonko. MRA ikoresha ikoranabuhanga rimeze nk’iya MRI kugira ngo irebe imiyoboro y’amaraso mu ijosi no mu bwonko. Ariko MRA ishobora gukubiyemo gutera umuti ugaragara mu mubiri mu muyoboro w’amaraso.
• Ubuvuzi bw’amajwi bw’umutima. Iki kizamini gishobora gukorwa kugira ngo hamenyekane niba ikibazo cy’umutima cyateye ibice by’amaraso byatumye habaho ikibazo cyo kubura amaraso. Ubuvuzi bw’amajwi bw’umutima busanzwe bwitwa transthoracic echocardiogram (TTE). TTE ikubiyemo kwambutsa igikoresho kitwa transducer ku gituza kugira ngo harebwe umutima. Transducer irerura amajwi anyura mu bice bitandukanye by’umutima, akora ishusho y’amajwi.

Cyangwa ushobora gukenera ubundi bwoko bw’ubuvuzi bw’amajwi bw’umutima bwitwa transesophageal echocardiogram (TEE). Umugozi woroshye ufite transducer ushyirwa mu muyoboro uhuza akanwa n’igifu, uzwi nka esophagus. Kubera ko esophagus iri inyuma y’umutima, TEE ishobora gukora amashusho meza kandi arambuye y’amajwi. Ibi bituma harebwa neza ibintu bimwe na bimwe, nka bimwe mu bice by’amaraso, bishobora kutaboneka neza mu buvuzi bw’amajwi bw’umutima busanzwe.

• Arteriography. Ubu buryo bukoreshwa kuri bamwe kugira ngo harebwe imiyoboro y’amaraso mu bwonko idasanzwe iboneka mu mashusho ya X-ray. Umuganga w’amashusho ashyiramo umugozi muto woroshye witwa catheter mu gice gito, akenshi mu gice cy’imbere y’amaguru.

Catheter iyoborwa mu mihombo y’amaraso ikomeye maze ijya mu muyoboro wa carotid cyangwa vertebral mu ijosi. Hanyuma umuti ugaragara mu mubiri uterwa muri catheter. Uwo muti utuma imiyoboro y’amaraso iboneka ku mashusho ya X-ray.

Isuzumwa ry’umubiri n’ibizamini. Umuganga wawe akora isuzuma ry’umubiri n’isuzumwa ry’ubwonko. Ibizamini by’ubuhanga bwo kubona, imiterere y’amaso, kuvuga no kuvuga, imbaraga, imikorere y’imitsi, n’uburyo bw’ubwenge birimo.

Umuganga wawe ashobora gukoresha stethoscope kugira ngo yumve umuyoboro wa carotid mu ijosi ryawe. Muri icyo kizamini, ijwi ryumvikana nk’iry’umuyaga ryitwa bruit rishobora gusobanura ko ufite atherosclerosis. Cyangwa umuganga wawe ashobora gukoresha ophthalmoscope. Icyo gikoresho kireba ibice bya cholesterol cyangwa ibice bya platelet bitwa emboli mu mihombo mito y’amaraso ya retina inyuma y’ijisho.

Ubuvuzi bw’amajwi bw’umutima. Iki kizamini gishobora gukorwa kugira ngo hamenyekane niba ikibazo cy’umutima cyateye ibice by’amaraso byatumye habaho ikibazo cyo kubura amaraso. Ubuvuzi bw’amajwi bw’umutima busanzwe bwitwa transthoracic echocardiogram (TTE). TTE ikubiyemo kwambutsa igikoresho kitwa transducer ku gituza kugira ngo harebwe umutima. Transducer irerura amajwi anyura mu bice bitandukanye by’umutima, akora ishusho y’amajwi.

Cyangwa ushobora gukenera ubundi bwoko bw’ubuvuzi bw’amajwi bw’umutima bwitwa transesophageal echocardiogram (TEE). Umugozi woroshye ufite transducer ushyirwa mu muyoboro uhuza akanwa n’igifu, uzwi nka esophagus. Kubera ko esophagus iri inyuma y’umutima, TEE ishobora gukora amashusho meza kandi arambuye y’amajwi. Ibi bituma harebwa neza ibintu bimwe na bimwe, nka bimwe mu bice by’amaraso, bishobora kutaboneka neza mu buvuzi bw’amajwi bw’umutima busanzwe.

Arteriography. Ubu buryo bukoreshwa kuri bamwe kugira ngo harebwe imiyoboro y’amaraso mu bwonko idasanzwe iboneka mu mashusho ya X-ray. Umuganga w’amashusho ashyiramo umugozi muto woroshye witwa catheter mu gice gito, akenshi mu gice cy’imbere y’amaguru.

Catheter iyoborwa mu mihombo y’amaraso ikomeye maze ijya mu muyoboro wa carotid cyangwa vertebral mu ijosi. Hanyuma umuti ugaragara mu mubiri uterwa muri catheter. Uwo muti utuma imiyoboro y’amaraso iboneka ku mashusho ya X-ray.

Iyo umuhanga mu buvuzi amenye icyateye ikibazo cy'uburwayi bwa ischemic attack, intego y'ubuvuzi ni ugukosora ikibazo no gukumira umwijima. Ushobora kuba ukeneye imiti yo gukumira imikaya y'amaraso. Cyangwa ushobora kuba ukeneye kubagwa.

Imiti myinshi ishobora kugabanya ibyago by'umwijima nyuma ya TIA. Umuhanga mu buvuzi akugira inama y'imiti ishingiye ku cyateye TIA, aho yabereye, ubwoko bwayo n'uburemere bw'inzitizi. Umuhanga mu buvuzi ashobora kwandika:

• Imiti igabanya ubukana bw'amaraso. Iyi miti ituma uturemangingabo tw'amaraso twitwa platelets tudakunda guhuza. Platelets zikunze guhuza zikaba imikaya iyo imiyoboro y'amaraso ikomeretse. Ibinyabutabire by'imikaya mu maraso na byo biri mu nzira.

  Aspirin ni yo miti ikunze gukoreshwa cyane igabanya ubukana bw'amaraso. Aspirin kandi ni yo miti ihenze cyane ifite ingaruka nke zishoboka. Indi miti ishobora gusimbura aspirin ni clopidogrel (Plavix).

  Aspirin na clopidogrel bishobora kwandikwa hamwe igihe kingana n'ukwezi kumwe nyuma ya TIA. Ubushakashatsi bwerekana ko gufata iyi miti ibiri hamwe mu bihe bimwe na bimwe bigabanya ibyago by'umwijima w'ejo hazaza kurusha gufata aspirin wenyine.

  Rimwe na rimwe imiti yombi ifatwa hamwe igihe kirekire. Ibi bishobora kugirwa inama iyo icyateye TIA ari ukwibasira kw'umuyoboro w'amaraso mu mutwe.

  Iyo hari inzitizi ikomeye y'umuyoboro mukuru w'amaraso, imiti ya cilostazol ishobora kwandikwa hamwe na aspirin cyangwa clopidogrel.

  Ubundi, umuhanga mu buvuzi ashobora kwandika ticagrelor (Brilinta) na aspirin iminsi 30 kugira ngo agabanye ibyago byo kongera kwibasirwa n'umwijima.

  Umuhanga mu buvuzi ashobora kandi gutekereza kwandika imiti ifatanye ya aspirin ya dose ntoya n'imiti igabanya ubukana bw'amaraso ya dipyridamole kugira ngo igabanye imikaya y'amaraso. Uburyo dipyridamole ikora butandukanye gato n'ubwa aspirin.

• Imiti igabanya imikaya y'amaraso. Iyi miti irimo heparin na warfarin (Jantoven). Igabanya ibyago by'imikaya y'amaraso ikora ku binya-butabire by'imikaya aho gukora ku mikorere ya platelets. Heparin ikoreshwa igihe gito kandi ntiyakunze gukoreshwa mu kuvura TIA.

Imiti igabanya ubukana bw'amaraso. Iyi miti ituma uturemangingabo tw'amaraso twitwa platelets tudakunda guhuza. Platelets zikunze guhuza zikaba imikaya iyo imiyoboro y'amaraso ikomeretse. Ibinyabutabire by'imikaya mu maraso na byo biri mu nzira.

Aspirin ni yo miti ikunze gukoreshwa cyane igabanya ubukana bw'amaraso. Aspirin kandi ni yo miti ihenze cyane ifite ingaruka nke zishoboka. Indi miti ishobora gusimbura aspirin ni clopidogrel (Plavix).

Aspirin na clopidogrel bishobora kwandikwa hamwe igihe kingana n'ukwezi kumwe nyuma ya TIA. Ubushakashatsi bwerekana ko gufata iyi miti ibiri hamwe mu bihe bimwe na bimwe bigabanya ibyago by'umwijima w'ejo hazaza kurusha gufata aspirin wenyine.

Rimwe na rimwe imiti yombi ifatwa hamwe igihe kirekire. Ibi bishobora kugirwa inama iyo icyateye TIA ari ukwibasira kw'umuyoboro w'amaraso mu mutwe.

Iyo hari inzitizi ikomeye y'umuyoboro mukuru w'amaraso, imiti ya cilostazol ishobora kwandikwa hamwe na aspirin cyangwa clopidogrel.

Ubundi, umuhanga mu buvuzi ashobora kwandika ticagrelor (Brilinta) na aspirin iminsi 30 kugira ngo agabanye ibyago byo kongera kwibasirwa n'umwijima.

Umuhanga mu buvuzi ashobora kandi gutekereza kwandika imiti ifatanye ya aspirin ya dose ntoya n'imiti igabanya ubukana bw'amaraso ya dipyridamole kugira ngo igabanye imikaya y'amaraso. Uburyo dipyridamole ikora butandukanye gato n'ubwa aspirin.

Iyi miti isaba gukurikiranwa neza. Niba ufite atrial fibrillation, umuhanga mu buvuzi ashobora kwandika imiti yo kurwanya imikaya y'amaraso yo kunywa nk'apixaban (Eliquis), rivaroxaban (Xarelto), edoxaban (Savaysa) cyangwa dabigatran (Pradaxa), bishobora kuba byiza kurusha warfarin kubera ko bigabanya ibyago byo kuva amaraso.

Muri carotid endarterectomy, umuganga abaga umuyoboro wa carotid kugira ngo akureho ibintu byawubujije.

Niba umuyoboro wa carotid mu ijosi ugoswe cyane, umuhanga mu buvuzi ashobora kugutekerezaho kubagwa bitwa carotid endarterectomy (end-ahr-tur-EK-tuh-me). Ubu buvuzi bwo gukumira bukurura imiyoboro ya carotid ku bintu by'amavuta mbere y'uko indi TIA cyangwa umwijima bibaho. Habanza gukorwa umukato kugira ngo umuyoboro ukingurwe, ibintu byawubujije bikurweho, hanyuma umuyoboro ugafunge.

Bamwe mu bantu bakeneye uburyo bwo kuvura bwitwa carotid angioplasty na stent placement. Ubu buryo bukoresha igikoresho kimera nk'umupira kugira ngo kingure umuyoboro w'amaraso ugoswe. Hanyuma umuyoboro muto w'umuringa witwa stent ushyirwa mu muyoboro w'amaraso kugira ngo ukomeze ukinguye.