1.Is stroke, stroke, brain hemorrhage, cerebral thrombosis, cerebral embolism and cerebral infarction the same thing?
A: Not exactly the same thing. Stroke and stroke are general terms for cerebrovascular accidents, which include hemorrhagic cerebrovascular disease and vaso-occlusive cerebrovascular disease, both of which can cause cerebral infarction (brain tissue necrosis). Cerebral hemorrhage is the abbreviation for hemorrhagic cerebrovascular disease. Cerebral thrombosis is mostly caused by cerebral arteries that are hardened and narrowed, and when the blood is hypercoagulated, the cerebral arteries are blocked by local clotting. Cerebral embolism is caused by the blockage of cerebral arteries by gas, liquid or solid floating materials in the blood outside the brain.
2.What is the relationship between cerebral embolism, a cerebrovascular disease, and carotid artery stenosis?
A: The two carotid arteries provide more than 80% of the blood supply to the brain tissue. Carotid artery stenosis not only reduces the blood supply to the brain, but also causes cerebrovascular disease because the atherosclerotic plaque in the stenosis can be broken, local thrombosis can be dislodged, and bleeding within the plaque can occur.
3.How many cerebral embolisms occur in this way?
A: The percentage of occurrence is high, and 75-90% of cerebrovascular diseases are ischemic strokes. Brain ischemia and stroke 60% are caused by extracranial cerebrovascular disease. 33% of Blaisdell’s summary atherosclerosis is located intracranially, 38% is located in the carotid bifurcation, in the United States, the incidence of carotid atherosclerosis in people over 60 years old is 70%, and about 50% of ischemic strokes are caused by carotid lesions.
4.Is the incidence rate of elderly people in China also this high?
A: There are no clear statistics on the incidence of stroke in China. However, we counted 530 patients aged 40-89 years (average 68.3 years) admitted to the General Department of Chaoyang Hospital in Beijing from January 1998 to July 2000, and all of them had carotid ultrasound examination after hospitalization without selection, including 380 men and 150 women. The results showed that 57.14% of those aged 60 years or older had carotid artery sclerosis. There were 42 cases (7.92%) with atherosclerotic stenosis of 50% or more. Among them, 6.67% were aged 50-59; 7.59% were aged 60-69; and 9.03% were aged 70-89. 17 cases (3.4%) were aged 50 or older with stenosis of 70% or more. Carotid artery sclerosis and stenosis, especially stenosis above 70%, were common in people aged 50-59, accounting for 4.4%, 60-69, 4.1% and 70-79, accounting for 3.3%.
5.Will I get brain embolism if I have carotid artery stenosis?
A: Of course not. However, if you have carotid stenosis, you are likely to get cerebral embolism. There is a risk of cerebral embolism when you have carotid stenosis, especially when the stenosis is severe
o Asymptomatic stenosis >80% Stroke, TIA or occlusion in 35% of people within 6 months
o Asymptomatic stenosis >75% 18% of those with neurological episodes per year and 5% of those with complete strokes
o Complete stroke with no pre-stroke symptoms is 3%.
o Patients with TIA symptoms have a stroke risk of at least 10% in the first year and approximately 6% per year thereafter, with progressive deterioration after 3 years.
Patients with significant stenosis in the internal carotid artery on the stroke side are unstable and have a recurrent stroke rate of about 9% per year.
6.How do I know that I have carotid stenosis?
A: Many people don’t know. Most people don’t have any discomfort. There are also many people who have symptoms of carotid stenosis.
7.What are the symptoms of carotid artery stenosis?
Answer
l Small stroke symptoms (TIA) – the most typical symptoms, which are manifested as
* Often sudden onset of dizziness; temporary darkness in one eye.
* Numbness and weakness in one arm and leg.
* Slurred speech, etc.
This symptom may appear for a few minutes or hours, but disappears completely within 24 hours, which is often called “mini-stroke” or “cerebrovascular spasm”.
Patients may also experience prolonged or permanent neurological damage – strokes, which are most likely caused by carotid stenosis.
l Some patients with severe carotid stenosis may present with symptoms of cerebral ischemia such as dizziness, blurred vision, and memory loss.
l There are also many patients without obvious symptoms, but mostly over 50 years old, often with hypertension, diabetes, atherosclerosis (such as coronary artery disease, limb ischemia, etc.)
8.Can treating patients with carotid artery stenosis prevent cerebral embolism?
A: Treatment of carotid stenosis can significantly reduce cerebral embolism
NASCET (North American Symptomatic Carotid Endarterectomy Trial), European Carotid Surgery Trial (ECST), and Asymptomatic Carotid Atherosclerosis Study. (ACAS) showed that.
Stroke incidence is significantly reduced by carotid endarterectomy in patients with stenosis of more than 50%.
- Patients with stenosis of 70%-99% had the best outcome with drug prophylaxis plus CEA At 24 months follow-up, the stroke rate was 26% on one side of the drug group compared with 9% for those who also underwent surgery (p<0.0001) The rate of stroke in those with stenosis of 70% or more was reduced by about 2/3 compared with drug prophylaxis
At long-term follow-up, these patients benefited from CEA over 8 years
- Stroke rate was 22.2% on one side of the drug group at 5 years in cases with stenosis of 50%-69% and 15.7% in those with combined surgery (P=0.045)
9.How to treat carotid artery stenosis?
A: Carotid endarterectomy endoluminal carotid angioplasty, carotid stenting to remove or dilate stenosis was performed in the United States in 1998 in 150,000 patients. The procedure is modest, effective, safe, and suitable for universal implementation. In recent years, an advanced technique using modern high-tech achievements, endoluminal carotid stenting, has been developed. It does not require any incision, but only a needle at the root of the thigh, and a device is introduced from the blood vessel to hold up a stent in the stenosis of the carotid artery, relieving the local stenosis and isolating the atherosclerotic plaque. It has a small damage and quick recovery, and has a vigorous life force.
10.How do I know if there is carotid stenosis?
A: Carotid ultrasound, CT, MRI, angiography, DSA – the most convenient one is carotid ultrasound.
We recommend that when available.
1.Age 50 years old or above, with hypertension, diabetes, atherosclerosis
2.People who often have dizziness and discomfort
3. Those with symptoms of mini-stroke or previous history of mini-stroke – carotid ultrasound can be considered to exclude carotid stenosis
4. Patients with stroke who have basically recovered from symptoms should be examined in time.
11.What kind of carotid artery stenosis needs surgical treatment?
A: It is not necessary to operate or put stents in the carotid artery when there is a problem, but the following four conditions require repair of carotid stenosis.
1. First, carotid artery stenosis is relatively severe, and surgery is most effective in preventing stenosis of 70-99%. Some male patients with symptomatic stenosis of 50-69% and male patients with asymptomatic stenosis of 60% or more may also be considered for surgery or stenting to prevent strokes.
2. people with frequent small strokes (TIA), except for other factors, should be actively prevented.
3. Patients who have had a stroke but recovered well if they have carotid stenosis. Within 3-4 years after the first attack, 20-45% will develop a complete stroke. Repair treatment should be actively carried out.
4. Examination reveals uneven surface and uneven texture of carotid artery sclerosis plaque, or ulcers or bleeding inside the plaque should be highly alert.
Of course, the basic physical conditions should also be available. If the carotid artery has been completely occluded or there has been a serious irreversible stroke, carotid artery stenosis repair loses its significance.
12. Is there any risk in treating carotid stenosis?
A: Generally, the risks are not significant.
The incidence of obvious complications is less than 3% and the incidence of serious complications is less than 1%.
The major ones are: transient neurological symptoms, most of which can be recovered quickly, with rare cases of hemiparesis and aphasia, and very few deaths (neurological or cardiogenic).
It is generally accepted that in patients with stenosis more than 75%, if he has a satisfactory medical environment, a long-term survival expectation, and a good doctor for treatment, the stroke and death rate of his surgery is less than 3%, this treatment is recommended.
13.Misconceptions on the issue of treating carotid stenosis
1.Unaware of the relationship between carotid stenosis and cerebral embolism
2.Do not admit the disease because there are no symptoms
3.Having a fluke mentality – how can I get cerebral embolism (the incidence only accounts for a small percentage)
4.Fear of surgery and money
14.The best way to deal with carotid artery stenosis is to
Prevention first
Improve the standard of living and quality of life
l find the hidden disease early treatment, it is too late to get a stroke
l The risk is not big, the investment is worth it
Middle-aged and elderly people should be alert to the existence of carotid artery stenosis and actively treat it – to prevent cerebral embolism
We hope that the middle-aged and elderly people will actively engage in prevention: “If you have conditions, make examination; if you have problems, see a doctor; quality of life, positive attitude”. We are also willing to collaborate with our colleagues to make this work for the benefit of the people a good one.