Mishonga yakavharika yecarotid arteries inosiyana neUS dunhu
Mishonga yakavharika yecarotid arteries inosiyana neUS dunhu
Anonim

Vanobatsirwa neMedicare mune mamwe matunhu eUnited States vanoratidzika kunge vanogona kuwana carotid endarterectomy, nzira yekuvhiya yekubvisa zvivharo mutsinga inoendesa ropa mumusoro, nepo avo vari kune mamwe matunhu vanowanzo gamuchira masitendi emamiriro akafanana, sekureva kweshumo. muChikunguru 26 chinyorwa cheArchives of Internal Medicine, imwe yemagazini eJAMA/Archives.

"Carotid endarterectomy yanga iri kurapwa kunokurudzirwa kune varwere vane extracranial carotid artery chirwere kubva pakaburitswa zvidzidzo zvakati wandei muma1990s vachienzanisa carotid endarterectomy nekurapa kwekurapa," vanyori vanonyora seruzivo rwekumashure muchinyorwa. Nekuvandudzwa kuchangobva kuitika kwemastents nemimwe michina inodzivirira kugwamba kweropa panguva yekuitwa kwetsinga, miedzo yakati wandei yakafananidza stents ne endarterectomy muvarwere vane carotid artery chirwere uye yakave nemhedzisiro yakasanganiswa maererano nekurwadziwa kwemoyo, sitiroko uye kufa.

Sarudzo yakaitwa muna 2004 yenyika yakatsigira kushandiswa kwecarotid artery stents kune vanobatsirwa neMedicare vane chirwere chezviratidzo uye vari panjodzi huru yekuvhiyiwa kana kutora chikamu mukuyedzwa kwekiriniki. Kuti vaone mapatani ekushandiswa kwestents kana endarterectomy kubva pachisarudzo ichi, Manesh R. Patel, MD, weDuke University School of Medicine, Durham, NC, uye vaaishanda navo vakaongorora zvirevo zvevarwere vane makore makumi matanhatu nemashanu zvichikwira kubva kuCenters for Medicare & Medicaid Services. kubva Ndira 1, 2003, kusvika Zvita 31, 2006.

Munguva iyi nguva, nyika yose ye carotid endarterectomy pakati pevabatsiri veMedicare yakaderera kubva ku3.2 pa1, 000 varwere pagore kusvika ku2.6 pa1,000 varwere pagore. Makodhi ekuda stenting akatanga kubuda mune data muna 2005; 0.3 maitiro akaitwa pavarwere 1,000 gore iroro, uye 0.4 pa1, 000 varwere vakagamuchira stents muna 2006.

Mushure mekugadzirisa maitiro ehuwandu hwevanhu uye kliniki, kuchinja kukuru kwenzvimbo kwakawanikwa mumatambudziko e revascularization. Nzvimbo dzeNew England, Mountain (Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah neWyoming) nePacific (Alaska, California, Hawaii, Oregon neWashington) matunhu aiwanzo kuve nemitengo yakaderera yemaitiro ese ari maviri, nepo East. South Central (Alabama, Kentucky, Mississippi neTennessee), East North Central (Illinois, Indiana, Michigan, Ohio neWisconsin) uye West North Central (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota neSouth Dakota) mitengo yepamusoro. Paive nemusiyano wakapetwa kapfumbamwe pakati peyepamusoro uye yakaderera mwero we endarterectomy munzvimbo dzese muna 2003 na2004 uye musiyano wakapetwa kanomwe muna 2005 na2006.

Muna 2005, 1.2 muzana yevarwere vakanga vafa mazuva 30 pashure pokubviswa kwe endarterectomy uye 6.8 muzana vakanga vafa pashure pegore rimwe. Izvi zvinofananidzwa nehuwandu hwekufa kwe2.3 muzana mushure memazuva makumi matatu uye 10.3 muzana mushure megore rimwe nokuda kwe carotid stenting.

"Kusiyana kwakasiyana kwenzvimbo kwakaonekwa mukushandiswa kwecarotid endarterectomy uye carotid stenting pakati pevanobatsirwa neMedicare uye kusiyanisa kwemaitiro ekufungidzira ecarotid akashandiswa kusati kwaitwa revascularization," vanyori vanonyora. "Uyezve, varume nevarwere vane chirwere chisati chaonekwa chechirwere chevascular peripheral vaiwanzoita carotid revascularization, uye varwere vane chirwere chisati chazivikanwa checoronary artery disease kana kuti carotid endarterectomy yekare vaiwanzoita carotid stenting. kuvandudzwa kwekubvumirana maererano nekiriniki yekufungidzira kwecarotid, senge chiyero chenyika chekushandisa kwakakodzera nzira, inodiwa."

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