Carotid artery stenosis and ischemic stroke The carotid artery provides more than 80% of the blood supply to the brain tissue. In addition to reduced blood supply to the brain, ischemic strokes often occur due to fragmentation of atherosclerotic plaques in the stenosis, local thrombosis, and intraplaque hemorrhage. 60% of ischemic strokes are caused by extracranial vascular disease. Treatment of carotid artery stenosis is an important tool for stroke prevention. Development of treatment for carotid stenosis The traditional treatment is surgery, i.e., performing carotid endarterectomy. Over the past 50 years, this procedure has contributed significantly to stroke prevention. In the last decade, with the development of endovascular interventional techniques, carotid endovenous angioplasty and carotid stenting have become more mature, especially with the development of cerebral protection technology, which provides safer conditions for carotid stenting techniques. Carotid stenting is a minimally invasive treatment technique that uses special devices to expand and support the stenosis by placing a metal stent in the stenosis of the carotid artery through the lumen of the vessel. It is a new and advantageous technique for treating carotid stenosis and preventing stroke because it is less invasive, easier to perform, has fewer complications, and has comparable results to traditional surgery. Carotid artery stenting The indications for stenting are similar to those for surgery and are based on the presence or absence of symptoms in the patient. Symptomatic patients are those who have had a minor stroke (TIA), such as transient blackness or numbness or weakness, or those who have had a previous stroke and have recovered after treatment. The treatment criteria for these patients should be slightly relaxed, e.g. carotid artery stenosis of more than 50% on the corresponding side can be considered. Patients without symptoms should have a stenosis of 60% or more before being considered. In general, patients with stenosis of 70% to 99% are more suitable for this treatment because they are more likely to have a stroke at this time. Of course, there are some clinical imaging indicators for reference, and stenting can also be performed in elderly and frail patients, in patients with difficult surgical techniques, and in patients with restenosis requiring retreatment. Stenting is simple and less invasive, and is usually performed under local anesthesia. The femoral artery is punctured at the root of the thigh for angiography, dilated with a balloon catheter, and the procedure is completed with a stent delivery catheter to deliver the stent to the stenosis and release it, and then dilate it if necessary. Stenting has few complications of surgical anesthesia and surgical injury, and the possible intraoperative neurological damage had hindered its clinical application. This is because the sclerotic plaque and thrombotic debris generated by vasodilation during the operation flowing down the bloodstream into the brain can cause cerebral embolism. With the progress of medical technology, a variety of brain protection devices have emerged, and currently there are three main types: one is the distal balloon obstruction type, another is the proximal balloon obstruction type, and another is the distal filter type. The distal filter type, for example, is a precision device produced with high technology. Before the treatment of the stenosis, the device is sent to the distal end of the stenosis, where it is released to form a filter like an umbrella, with many small holes in the “umbrella cloth” to allow blood to pass through, but slightly larger plaques and clots are blocked by the filter. After the operation is completed, the filter can be closed like an umbrella to bring out the plaque and thrombus collected in it. This greatly reduces the complications of carotid artery stenting. Stroke focuses on prevention The incidence of ischemic cerebral infarction was once high in Europe and the United States, and through decades of active prevention, the incidence has been significantly reduced. In China, most people still only use general drugs for prevention, and the concept of active prevention is not enough, which is an urgent problem to be solved. First, it is important to establish the concept that stroke can be actively prevented. Active treatment of carotid artery stenosis to prevent stroke, including surgical resection, endoluminal dilation, and stenting are the main means currently available. Surgical resection of carotid artery intima is one of the more mature prevention methods, and stenting is a new technique with less trauma and faster recovery. With the continuous improvement of brain protection technology, carotid artery stenting has become a more perfect treatment method with less trauma and better results. How do I know if I have carotid artery stenosis? We divide patients into two categories, those who are asymptomatic and those who are symptomatic. The asymptomatic ones are not easy to detect, but make up the majority. How do you detect them? We say that if you are a person who values your quality of life, you should undergo some necessary tests, especially if you are over 50 years old and have hypertension, coronary artery or peripheral arteriosclerosis, you should consider a carotid ultrasound to exclude carotid artery stenosis. There are also some patients with carotid stenosis who show some symptoms, such as vascular murmurs that can be heard in the neck in a few people, but are not easily detected. More common are TIA episodes, which are characterized by sudden onset of dizziness, temporary darkness in one eye, numbness and weakness in the arms and legs, and slurred speech. The symptoms can take only a few minutes or hours to appear, but disappear completely within 24 hours, which is often referred to as a “mini-stroke”. Don’t delay to see a doctor if you have this condition. Patients who have already had a cerebral embolism should also be checked for carotid artery stenosis as long as they recover well, because these patients will suffer from cerebral embolism again, and it will be a more serious cerebral embolism. How to check for carotid stenosis? It is very simple. A carotid ultrasound can make a clear diagnosis when available.