Carotid stenosis

Carotid stenosis refers to the narrowing of the carotid artery, mostly caused by the formation of atheromatous plaque in the carotid bifurcation. Calcification, ulceration, necrosis, plaque detachment may occur in the stenosis, and severe stroke may cause stroke (stroke, ie acute cerebrovascular disease). Carotid stenosis occurs mostly in the elderly. Therefore, knowledge about carotid stenosis is extremely important for the elderly.

? Cause?

1. Atherosclerosis. Atherosclerosis is the most common cause of carotid stenosis (about 90%). It is characterized by an ever-increasing plaque that eventually leads to a narrowing of the carotid lumen and a decrease in forward blood flow. Atherosclerosis can also affect other arteries, increasing the risk of cardiovascular and cerebrovascular diseases.

2. Fibromuscular dysplasia. This is a non-atherosclerotic degenerative disease that can affect medium-diameter arteries such as the renal artery and carotid artery. The main manifestation of fibromuscular dysplasia is transient ischemic attack, which is more common in women.

3. Carotid dissection. Carotid dissection is caused by blunt injury or sudden neck extension, and a few can occur spontaneously. The dissection may cause tearing of the intima of the blood vessel, resulting in narrowing of the lumen and induction of thrombosis.

? symptom?

1. Cerebral ischemia symptoms. There may be tinnitus, dizziness, blurred vision, headache, memory loss, lethargy, multiple dreams and ocular ischemic manifestations (loss of vision, hemianopia, diplopia).

2. Transient loss of local nerve function, manifested as a temporary disturbance of one limb’s sensory or motor function, transient monocular blindness or aphasia. It usually lasts for a few minutes and can be fully recovered within 24 hours.

3. Ischemic stroke. Common side limb sensory disturbance, hemiplegia, aphasia, severe coma, and corresponding neurological signs and imaging features.

There are also many patients with carotid stenosis without any symptoms. Only during the physical examination, the carotid artery beats weakened or disappeared, and the cerebral root or carotid artery smelled vascular murmur. This carotid stenosis is called asymptomatic carotid stenosis.

? diagnosis?

Old age (over 60 years old), smoking, obesity, hypertension, diabetes, hyperlipidemia, etc. are all high risk factors for carotid stenosis. If there is a corresponding symptom, a physical examination should be performed to detect the presence or absence of carotid vascular murmur. Can do neck color ultrasound, neck MRA scan and carotid CT angiography three examinations.

? treatment?

※Comprehensive Treatment

1. Actively quit smoking. Smoking increases the risk of carotid stenosis.

2. Supplement nutrition. Keep a low-sodium diet and eat at least one serving of vegetables or fruits a day.

3. Strengthen exercise. Take 40 minutes of moderate-intensity exercise, 3 to 4 times a week.

4. Maintain weight. Obesity is a risk factor for stroke, and obese people should actively lose weight.

※medical treatement

1. Antiplatelet therapy. All patients with asymptomatic carotid stenosis were treated with aspirin. Aspirin allergies can be treated with clopidogrel.

2. Treatment of abnormal blood lipids. The use of statins to treat dyslipidemia can effectively reduce the incidence of carotid stenosis. Clinical studies have shown that the incidence of carotid stenosis is reduced by 25% in patients with hyperlipidemia treated with simvastatin for 5 years. High-intensity statins such as atorvastatin or rosuvastatin are recommended. For those who cannot tolerate statins, other lipid-lowering drugs may be considered.

3. Control high blood pressure. Hypertension is a risk factor for carotid stenosis. It should be actively treated with drugs to achieve high blood pressure and stability.

4. Treat diabetes. Diabetes is significantly associated with the severity of carotid stenosis, and glycosylated hemoglobin should be controlled at around 7%.

※Surgical intervention

The carotid artery was incised, the internal plaque and hyperplastic tissue were removed, and the incision was sutured, which was called “carotid endarterectomy” or “carotid endarterectomy”. Adapted to the following three situations: 1 stenosis >50% and ischemic symptoms; 2 stenosis >70%, no obvious symptoms; 3 stenosis <70%, no obvious symptoms, but plaque instability and easy to fall off.

Contraindications: 1 patients with high carotid bifurcation rate, wide plaque range, long stenosis; 2 patients with history of neck surgery or neck radiotherapy; 3 poor physical condition, can not tolerate surgery .

It should be noted that preoperative patients should have some knowledge of the operation, and the doctor should do a preoperative evaluation to understand the intracranial blood supply. The neck should be controlled after surgery to prevent bleeding from the wound. After discharge, you should control your blood pressure, maintain good eating habits, and take anti-platelet aggregation drugs on time.