“Carotid artery stenosis is an unfamiliar term to many people, and is often first heard of during medical checkups or hospital visits for other diseases. But the serious consequences are familiar – stroke, or more precisely, ischemic stroke. According to statistics, nearly 1/3 of all ischemic strokes are related to carotid artery stenosis. But don’t worry, let’s take a closer look at carotid artery stenosis so that we can be aware of it and not panic.
How does carotid artery stenosis occur?
More than 90% of carotid stenosis is related to atherosclerosis. Modern society is gradually aging, and at the same time, the improvement of economic conditions is accompanied by a change in the structure of the diet, and the problem of excess nutrition and body fat accumulation is becoming more and more prominent. Under the combined effect of age and excess fat, excess lipids are deposited in the blood vessels over time, forming atherosclerotic plaques; if the plaques increase in size in the carotid arteries to the point where the lumen becomes thin, it is manifested as carotid stenosis.
The carotid artery has been a “hardest hit” area for atherosclerosis, which is related to the anatomical structure of the carotid artery. The carotid artery consists of the common carotid artery, the external carotid artery and the internal carotid artery. If a blood vessel is like a river, then when a large blood vessel splits into two, just like the bifurcated part of the river, fluid dynamics will change, and the blood in it will form turbulence, eddy flow and other turbulent flow states, just as the bifurcated part of the river is prone to sediment deposition, impurities in the blood (such as lipids) are more likely to be deposited; at the same time, the bifurcated part is more susceptible to the impact of blood flow than ordinary blood vessels, and is also more prone to damage. At the same time, the bifurcation site is more vulnerable to the impact of blood flow than the general blood vessels, and is also more likely to be damaged, and in the process of self-repair of the body, it is also more likely to form local lipid plaques. Over time, more and more plaque accumulates, and the blood vessels become smaller and smaller, so carotid stenosis occurs.
When the plaque gradually grows (carotid artery stenosis 50%-70%), the influence of plaque on blood flow becomes obvious, and some thrombotic material which can be easily dislodged from the plaque may be generated locally, and the volume is also larger than the previous “small debris”, which will infarct the thicker cerebral vessels and cause more serious This can lead to more serious cerebral infarction, i.e., ischemic stroke, which can lead to loss of speech, limb function, hemiparesis, and a number of other serious problems. Of course, when carotid artery stenosis is >50%, brain infarction does not always occur, but if we continue to leave it alone, the plaque will expand further, and the threat of death will be greater.
Four major dangers of carotid artery stenosis
1，Dizziness, difficulty in movement, blurred vision
If a carotid plaque grows unevenly, it can break up and produce debris. When these fragments fall off and float into the brain with the blood flow, they can block peripheral blood vessels and cause ischemia or even necrosis in a small area of brain tissue. The blood vessels blocked by the fine debris are small, so the area of brain tissue ischemia caused is very small, even asymptomatic, of course, most of the manifestations are short time dizziness, difficulty in movement, blurred vision, etc..
2，Causes stroke, even fatal
Nearly half of the clinical strokes are caused by carotid artery stenosis and plaque detachment. This is because if the blood vessel blocked by the debris of carotid plaque is thicker, the area of necrotic brain tissue formed is larger, which can lead to the appearance of real cerebral infarction and various symptoms of stroke or stroke: such as dizziness, fainting, weakness, fall, hemiplegia, aphasia, hemianopia, balance disorder, cognitive impairment, incontinence, mobility disorder, etc. Serious cases are left with sequelae or even life-threatening.
3，Thrombosis, resulting in acute cerebral infarction
In a small number of patients, carotid stenosis can be complicated by thrombosis, which can suddenly block blood flow or dislodge the thrombus and block blood flow to the distal brain, causing acute cerebral infarction and stroke.
4，Causes hearing and vision loss
Hearing loss is also a risk sign of stroke. In addition, the artery that supplies blood to the eye is a branch of the carotid artery. Carotid artery stenosis, plaque can directly lead to insufficient blood and oxygen supply to the retina, causing visual impairment in one and both eyes, and progressive aggravation.
Drugs, surgery, each in its own way
You may ask, “People will always grow old, and carotid arteries will always age and harden, these are natural laws, irreversible, so we can do nothing about carotid stenosis? Of course not. There are many options available to treat carotid stenosis.
Medication is used throughout the course of carotid stenosis. As soon as a physical examination reveals the presence of carotid stenosis, even if the degree of stenosis is <50%, medication should be started.
There are two main categories of drugs used to treat carotid stenosis. One category is antiplatelet and anticoagulant drugs, such as aspirin and clopidogrel. The other category is lipid-lowering drugs, mainly statins, such as atorvastatin, etc. For patients with carotid stenosis, even if their blood lipids are not high, they need to consider applying lipid-lowering drugs, which can reduce the rate of plaque progression.
In addition, for patients with carotid stenosis accompanied by other underlying diseases, such as hypertension, diabetes and metabolic syndrome, strict control of the underlying diseases is needed to reduce the risk of stroke.
Drug therapy can slow down the progression of carotid stenosis, but it does not shrink and reverse the formed plaque. For patients with higher risk level, surgical treatment still needs to be considered.
Carotid endarterectomy (CEA)
Carotid endarterectomy is considered an effective method to prevent stroke in patients with carotid stenosis and is the most classic procedure for treating carotid stenosis.
For symptomatic patients with carotid stenosis >50% (e.g., occurrence of blackout, mini-stroke, transient ischemia, etc.), carotid endarterectomy can be used; for asymptomatic patients, this procedure is generally considered for aggressive treatment only when the carotid stenosis is >70%.
Carotid endarterectomy involves cutting open the carotid artery and removing the plaque that causes significant stenosis, which is relatively complete because the plaque is removed. It is an open procedure and is suitable for patients who are younger (under 75 years old) and in good general condition.
The procedure is invasive and may cause damage to the peripheral nerves and blood vessels; the plaque debris may be dislodged during the procedure and cause brain infarction. Therefore, patients should cooperate with doctors for standard medication and preoperative evaluation to minimize the risk.
Carotid artery stenting (CAS)
Carotid stenting is a relatively minimally invasive treatment for patients who are older, in relatively poor general condition, at high risk of anesthesia, or unsuitable for carotid endarterectomy.
Carotid stenting is a procedure in which a stent is placed in the carotid artery stenosis to physically “stiffen” the stenosis and improve carotid blood flow on the one hand, and stabilize the plaque with the stent on the other hand to reduce plaque dislodgement.
Since the plaque is still present but “squeezed” to one side, this method is not as complete as carotid endarterectomy; over time, in a small number of patients, new intimal hyperplasia may occur in the stent and block the stent. The advantage is that the minimally invasive procedure rarely causes neurological complications; the special carotid artery protection device also reduces the probability of stroke due to intraoperative plaque debris dislodgement.
However, it should be noted that even if surgery is chosen, the pathological basis of carotid stenosis is still present and medication must be administered throughout the treatment.
Daily life needs attention
Once a carotid plaque is formed, it is irreversible unless it is surgically removed, but this does not mean that we do not have to do anything in our daily life.
All patients with carotid artery stenosis should be reviewed regularly according to the severity of the disease and in accordance with medical advice. For patients with carotid artery stenosis <30%, even if they have not started medication, they should be reviewed once every 3 to 6 months.
Keep your mouth shut and your legs open.
That is, maintain good lifestyle habits. For patients with carotid artery stenosis, this can slow down the development of plaque to a certain extent; for those who have not yet developed carotid artery stenosis, it can prevent or delay the occurrence of carotid artery stenosis.
In particular, it is important to avoid smoking and alcohol, and to avoid high-fat and high-sugar (including high-carbohydrate) diets. It should be emphasized that smoking is one of the main risk factors for carotid atherosclerosis, and patients with carotid stenosis who smoke should be strictly asked to quit smoking.
Advocating moderate exercise, daily morning, midday and evening walks, especially after dinner, is helpful for the control of carotid stenosis.
Drink a moderate amount of water.
Drinking more water in moderation can make the blood relatively dilute some.
As you can see, although carotid stenosis is a major enemy of people’s health, as long as we master the method of dealing with it, regular checkups, and standardized treatment with doctors, we can choke its “throat” so that it can no longer do harm.