1.What are the main causes of carotid artery stenosis?
The main cause of carotid artery stenosis is atherosclerosis, which accounts for more than 90% of the cases. In addition, there are also rare causes such as aortitis, trauma and radiation injury.
2.What are the risk factors for carotid artery stenosis?
Carotid artery stenosis due to atherosclerosis is mostly seen in middle-aged and elderly people, and is often accompanied by a variety of cardiovascular risk factors.
Carotid artery stenosis caused by carotid arteritis is most common in adolescents, especially in young women.
Carotid artery stenosis caused by injury or radiation has a history of corresponding injury or radiation exposure before the onset of the disease.
3.Classification of carotid artery stenosis
Carotid stenosis is clinically classified into two categories: symptomatic and asymptomatic, depending on whether the stenosis produces cerebral ischemic symptoms.
1.Symptomatic carotid stenosis
2.Asymptomatic carotid stenosis
4.What are the main symptoms of carotid stenosis?
(1) Cerebral ischemic symptoms: tinnitus, vertigo, blackness, blurred vision, dizziness, headache, insomnia, memory loss, drowsiness, and dreaminess may be present. Ocular ischemia is manifested as vision loss, hemianopia, diplopia, etc. Many patients with carotid stenosis do not have any clinical signs and symptoms of the nervous system. Sometimes, only weakened or absent carotid artery pulsations are found during physical examination, and vascular murmurs are heard at the root of the neck or at the carotid artery line.
(2) Transient loss of local neurological function in TIA: Clinical manifestations include transient impairment of sensory or motor function of one limb, transient monocular blindness or aphasia, etc., usually lasting only a few minutes, with complete recovery within 24h after onset. There is no focal lesion on imaging examination.
(3) Ischemic stroke: Common clinical symptoms include sensory impairment of one limb, hemiparesis, aphasia, cerebral nerve damage, and in severe cases, coma, with corresponding neurological signs and imaging features.
Asymptomatic carotid artery stenosis, especially severe stenosis or plaque ulceration, is recognized as a “high-risk lesion” and is receiving more and more attention.
5.Which patients need to be screened for carotid stenosis?
Atherosclerosis is a systemic disease. Age (>60 years), sex (male), long-term smoking, obesity, hypertension, diabetes, hyperlipidemia and other risk factors for cardiovascular disease are also applicable to screening for carotid artery stenosis due to atherosclerosis.
High-risk groups include patients with TIA and ischemic stroke, patients with lower extremity atherosclerotic occlusive disease, patients with coronary artery disease (especially those requiring coronary artery bypass or intervention) and those with carotid artery vascular murmurs detected during physical examination.
6.Diagnostic basis for patients with carotid artery stenosis
Diagnosis: Carotid artery stenosis can be diagnosed mostly through clinical manifestations and non-invasive auxiliary examinations, but DSA is still an indispensable basis for confirming the diagnosis and formulating the plan.
7.What are the auxiliary tests for carotid artery stenosis?
1.Doppler-ultrasound examination
2.Magnetic resonance angiography
3.CT angiography
4.Digital subtraction angiography, digital subtraction angiography (DSA) is still the “gold standard” for the diagnosis of carotid artery stenosis.
8.Grading of carotid artery stenosis
The degree of internal carotid artery stenosis is divided into 4 grades.
①Mild stenosis, where the internal diameter of the artery is reduced by <30%.
②Moderate stenosis, with a 30% to 69% reduction in the internal diameter of the artery.
③Severe stenosis, with a 70% to 99% reduction in the internal diameter of the artery.
④complete occlusion.
9.What are the treatment objectives and methods for carotid stenosis?
The purpose of treatment for carotid stenosis is to improve cerebral blood supply, correct or relieve the symptoms of cerebral ischemia; prevent TIA and ischemic stroke. Treatment is based on the degree of carotid stenosis and the patient’s symptoms, including medical treatment, surgical treatment and interventional treatment.
10. Indications and methods of medical treatment for carotid stenosis
Conservative medical treatment aims to reduce the symptoms of cerebral ischemia, reduce the risk of stroke, and control existing diseases such as hypertension, diabetes, hyperlipidemia and coronary heart disease.
Conservative medical treatment includes the following.
(1) Reducing body weight.
(2) Quit smoking.
(3) Limiting alcohol consumption.
(4) Anti-platelet aggregation therapy: Many large randomized, prospective multicenter clinical trials have confirmed that anti-platelet aggregation drugs can significantly reduce the incidence of cerebral ischemic disease, and the drugs commonly used in clinical practice are aspirin and ticlopidine (trade name RENKID).
(5) Improve the symptoms of cerebral ischemia.
(6) Regular ultrasound examination, dynamic monitoring of changes in the condition.
11.The purpose of surgical treatment of carotid artery stenosis
The aim of surgical treatment of carotid stenosis is to prevent the occurrence of stroke, followed by the prevention and slowing down of TIA episodes. The standard surgical procedures are carotid endarterectomy (CEA) and stenting of carotid stenosis (CAS)
12. Indications for CEA and CAS surgery
(i) Carotid artery stenosis (70% to 99%) with symptoms ipsilateral to the stenosis, indications.
②Carotid stenosis (30% to 69%) with symptoms of cerebral ischemia on the ipsilateral side of the stenosis is considered.
(iii) for carotid artery stenosis (0% to 29%) with symptoms ipsilateral to the stenosis, treatment is not beneficial.
④For asymptomatic carotid artery stenosis (60% to 99%), it is beneficial.
13.What are the main complications of CEA?
Complications of CE include perioperative stroke and death; and cerebral nerve injury, wound hematoma infection, postoperative hypertension, and postoperative hyperperfusion syndrome; the incidence of myocardial infarction and hypotension is low.
14.What are the main complications of CAS?
Complications of carotid artery stenting.
①Postoperative restenosis rate <5%.
②Low incidence of stent deformation, collapse, and displacement.
③Other complications such as vasospasm, stroke, hematoma formation, etc. are similar to PTA.
15.Dietary guidance for carotid artery stenosis
(1) Dietary prescriptions for carotid stenosis.
Eat a balanced diet, more fruits and vegetables and other high-fiber foods, more eggs, soybeans and other high-protein foods, pay attention to a light diet, and moderate exercise can be performed
(2) What foods are best not to eat for carotid artery stenosis?
Avoid smoking, alcohol, spicy, coffee and other stimulating foods
16.Preventive health measures for carotid stenosis
1.Because the main causes of this disease are atherosclerosis, aortitis, trauma and radiation injury, active treatment and prevention of the original disease is the key to prevent this disease.
2. Carotid percutaneous transluminal angioplasty or carotid stenting implantation can be done to eliminate potential sources of emboli and prevent the occurrence of stroke if significant carotid stenosis is found.