According to statistics, 30% of adults in China have carotid atherosclerotic plaques, the most among the elderly, and now it is gradually showing a younger trend. Many people and even some doctors understand plaque as simply: soft plaque is dangerous, hard plaque is not dangerous, because soft plaque is unstable plaque will easily fall off and cause brain infarction, while hard plaque is stable plaque will not fall off. In fact, this perception is not entirely correct. The soft plaque and hard plaque that people talk about are actually talking about the stability of plaque. Stability is an important indicator to determine the risk level of plaque, while soft and hard is only one of the influencing factors, not the only criterion to determine, but also based on the structural characteristics of plaque, such as morphology, size, location and internal echo, as well as the existence of cardiovascular and cerebrovascular disease risk factors and control status of patients themselves. Carotid atherosclerotic plaque is a mass-like structure formed by the aggregation of platelets and lipids present in the blood flow as a result of damage to the carotid artery vessel wall caused by various risk factors. It is like the oil that accumulates in the kitchen sewer pipes and causes clogging of the sewer over time. It has a complex composition, with some being more stable and others easily broken. Normally, the plaque is protected by a fibrous cap wrapped around its surface. Fragile plaque, when emotional excitement, strenuous exercise, alcoholism, cold, etc., cause elevated blood pressure, blood flow shock or vascular spasm, the fibrous cap will rupture, causing lipids and other substances within the plaque to gush out, leading to the aggregation of red blood cells, platelets, etc., and the formation of platelet thrombosis. If it blocks the cerebral blood vessels, it can cause acute cerebral infarction or cerebral blood supply deficiency. Therefore, vulnerable plaque can be said to be an “untimely bomb” in human body, as long as there are enough detonation conditions (cerebrovascular disease risk factors: high blood pressure, diabetes, high blood lipid, smoking and other long-term poor control), it may cause serious cardiovascular and cerebrovascular events at any time, endangering the lives of patients or causing disability. So how to identify the good and bad plaque (whether it is stable). First of all, look at the shape. The plaque with smooth surface and regular shape is not easy to rupture; the plaque with unsmooth appearance and irregular shape is easy to rupture under the impact of blood flow, even if the structure is hard. For example, plaques with uneven thickness of the superficial fiber cap are easy to rupture when encountering blood pressure ups and downs. After rupture, atheromatous material is released from the plaque, which can easily form a thrombus. Dislodgment of the thrombus causes embolism of the main trunk of the cerebral artery, which may cause a large cerebral infarction. Secondly, look at the composition. The calcified plaque is hard and should be more stable by common sense, but if the plaque shape is irregular, it is also easy to rupture. After rupture, the fine plaque is washed to the intracranial vessels, forming brain infarction. This kind of infarction is difficult to be removed by thrombolysis and other treatments. Finally, the location of the plaque is also important. If the plaque is in the branch part of the blood vessel, it is subjected to different blood flow impact, which affects its stability and also easily causes the rupture of the plaque and the occurrence of thrombosis. Therefore, we don’t need to be nervous and heavy-minded after checking out the soft plaque; of course, we can never rest on our laurels and neglect to take precautions after finding out the hard plaque. Many people have misconceptions in life. Even if a carotid plaque is found in one hospital, even if it is not serious and the degree of carotid artery stenosis is less than 50%, they are still worried about a sudden stroke one day and often move around to several hospitals for examination. In fact, from birth, blood vessels start to grow “garbage” like pipes, and plaque appears in the walls. As time goes by, they slowly thicken and harden, leading to gradual narrowing of the blood vessels. This process does not happen overnight, but is formed over time. If the plaque is stable and the stenosis is not severe, regular review is possible. If carotid artery stenosis is less than 50% by ultrasound, it should be checked once every one to two years on average; if the stenosis is 50%-69%, it should be checked once every six months to a year, and under the guidance of neurologist, active lipid lowering, blood pressure lowering, sugar regulation, etc. to reduce the risk; if the stenosis is more than 70%, it should be checked once every 3-6 months; if there are also symptoms of cerebral blood supply deficiency, it should undergo surgical operation (plaque removal) or undergo stent intervention. For patients who have already had a stroke, carotid ultrasound can be performed every six months or once a year for those with severe stenosis (70%) or less. For patients with severe stenosis (70%-99%) due to plaque, especially those with clinical symptoms of cerebral ischemia, carotid endarterectomy (plaque removal) or stent intervention is recommended as soon as possible. Medications for plaque stabilization and thrombosis prevention: aspirin and atorvastatin, but make sure that blood pressure and blood sugar are stable and quit smoking and alcohol.