What is “carotid plaque”? We all know that stroke is one of the top three life-threatening diseases, with high morbidity, mortality and disability rates. Nearly half of all cerebral infarctions are caused by carotid artery stenosis. The bifurcation of the carotid artery is like the bifurcation of a river, where sediment is deposited to form a delta and block the river, just as plaque blocks the blood flow. The carotid artery wall is divided into three layers: intima, media and tunica, and the intima-media thickness (IMT) is generally less than 1mm under ultrasound. The most important factor pathological mechanism for the formation of carotid plaque is atherosclerosis. What is the risk of carotid plaque? There is no need to worry about carotid plaque, for example, the carotid artery is like a water pipe at home, the longer it is used, the more likely it is that the scale will hang on the wall. According to statistics, 62% of people over 40 years old in the United States have carotid plaque on ultrasound screening, and the ultrasound screening results in China also show that the detection rate of carotid plaque in middle-aged and elderly people reaches 60.3%. Therefore, there is no need to be overly concerned when intima-media thickening or plaque is found in the carotid artery without lumen narrowing. However, carotid intima-media thickening or plaque often indicates the condition of systemic atherosclerosis in the body, which needs to be taken seriously and reviewed regularly. If the plaque increases in size and causes luminal narrowing, there is a risk of dislodgement. Common clinical symptoms include transient ischemic attack (TIA), or “mini-stroke”: sudden onset of dizziness, temporary darkness in one eye, numbness and weakness in arms and legs, slurred speech, weakness in one limb, unstable holding, crooked mouth, etc., often recovering within 24 hours. These manifestations are caused by the dislodgement of small plaques of carotid atherosclerosis, resulting in the embolization of small intracranial arteries, which is also an important “early warning” signal. If the dislodgement of larger plaques continues to occur, resulting in the embolization of relatively large intracranial arteries, it may lead to acute cerebral infarction, causing permanent hemiplegia, hemianesthesia, hemianopia and speech dysfunction This can lead to acute cerebral infarction, causing permanent hemiparesis, hemianesthesia, hemianopsia, speech impairment, etc. In addition, chronic brain damage can be caused by insufficient blood supply to the brain due to carotid stenosis, which can lead to dizziness, vision loss, and a decrease in higher intellectual activities such as intelligence and social function. In addition to luminal stenosis suggesting carotid plaque danger, the stability of the plaque itself is also drawing increasing attention. The aforementioned ultrasonography, ultrasonography or MRI suggesting uneven plaque echogenicity, ulcerated plaques, intraplaque neovascularization, and carotid plaques that have experienced plaque dislodgement events, these types of plaques may be more likely to lead to cerebral infarction, and all of them need extra attention and timely treatment according to the situation. How is carotid plaque treated? Similar to limescale not blocking the pipeline, plaque has not caused carotid stenosis and there is no need for major pipeline repair. The primary treatment measures are to slow down the growth of plaque, prevent and control the risk factors that trigger carotid plaque, control blood pressure, blood sugar and blood lipids; avoid high salt and high fat diet, quit smoking if you smoke, develop good living habits, ensure sleep quality, strengthen exercise and have regular medical checkups. Some patients have more combined risk factors and need to take antiplatelet drugs. If blood lipids remain high after lifestyle adjustments, lipid-lowering medications are also recommended. There is no drug that can eliminate carotid plaque with certainty, but adjusting lifestyle and controlling risk factors can slow down the growth of plaque. The growth of plaque is slow, so there is no need to review it too often in the early stage, annual review of carotid ultrasound is enough. When the plaque grows and causes severe carotid stenosis (>70% stenosis) or symptomatic carotid stenosis (>50% stenosis) with “warning” signs, surgical treatment is required. Carotid endarterectomy is the gold standard for the treatment of carotid stenosis. Numerous clinical studies have well documented the safety and importance of carotid endarterectomy for plaque debridement. The safety, important value and effectiveness of stroke prevention. An experienced vascular surgeon can perform this procedure skillfully, and the appropriate application of intraoperative diverter tubes as well as patches increases the safety of the procedure and improves the efficacy. In recent years, with the advancement of minimally invasive treatment techniques, especially the application of cerebral protection devices, carotid balloon dilated stenting has been increasingly used in the treatment of carotid artery stenosis. Moreover, this technique has obvious advantages: less trauma, faster recovery, and much shorter hospital stay, especially for elderly patients with cardiopulmonary vascular disease who can prioritize this treatment measure, which can reduce the occurrence of myocardial infarction.