Stroke, hypertension and coronary heart disease are the three major killers that seriously threaten human health in this century, among which stroke has a higher incidence in China and is highly fatal and disabling. Even if the patient is lucky enough to escape from the clutches of death, most of them will be left with symptoms such as dementia, hemiplegia or even total paralysis, which will bring great pain and burden to individuals and families. So how to effectively prevent stroke? This has been the most concerned issue for medical workers and patients. At present, it is widely recognized in the medical field that carotid atherosclerotic plaque is the main culprit causing stroke! Liu Ping, Peripheral Vascular Department, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine What is carotid plaque? We liken it to the “garbage” in the blood vessels. The human body is like a big house, the blood vessels are like the sewer pipes in the house. People eat grains and cereals, coupled with the stressful rhythm of life and long-term smoking and other bad habits, blood vessels in the “garbage” more and more, blood vessel elasticity gradually poor, thickening of the lining, blood vessels gradually formed atheromatous plaque caused by the narrowing of the lumen, and finally, like a house in disrepair, the downpipe blockage situation. At this time, people will show signs of insufficient blood supply to the brain, such as: poor sleep, easy to wake up, dreamy, difficult to fall asleep; personality anomalies, irritability, agitation; decline in working ability, memory loss; severe can also appear dizziness, lightheadedness, tinnitus, black vision, unsteady gait, stiffness and other symptoms. If the carotid plaque is dislodged, an embolus will be formed, which will enter the cerebral blood vessels straight up the blood flow and cause a stroke. How to detect carotid plaque? First of all, when a patient has the above mentioned symptoms of insufficient blood supply to the brain, he/she should attach great importance to the examination of carotid artery. In addition, with the accelerated pace of life, carotid atherosclerosis is gradually becoming younger, and we have seen cases of severe carotid artery stenosis in men in their 30s. Therefore, we recommend that people over 40 years old, especially those with a long history of smoking, should undergo regular carotid vascular screening even if they have no symptoms. One of the simplest, cost-effective and non-invasive screening tests is carotid ultrasound, which can detect carotid atherosclerotic lesions at an early stage, measure the size of the plaque and evaluate the degree of lumen narrowing. This test is widely used in most hospitals because it is easy to perform. However, vascular ultrasound is subject to human subjective factors and may have interpretation errors, in short, an experienced ultrasound doctor and an inexperienced ultrasound doctor may have artificially different interpretation results of the carotid artery of the same patient. Therefore, carotid angiography and dual source 64-row CT angiography, which are relatively more objective and accurate, have become the gold standard for diagnosing carotid artery stenosis. These tests can be done in a single visit to our hospital. How to deal with carotid plaque? Conventional medication is essential, such as antiplatelet drug aspirin and statin lipid-lowering drugs. However, for carotid artery stenosis of more than 50% of the lumen, medication alone will not solve the problem. This is where we need to take surgical and interventional treatments. At present, the most commonly used methods are carotid endarterectomy and carotid stenting. Carotid endarterectomy has a history of nearly 60 years since Spence’s first successful operation in 1951, and carotid stenting has a history of only 20 years. After a large number of foreign case reports, multi-center comparative studies, it has been proved that carotid endarterectomy is superior to carotid stenting, and can better solve the problem of carotid artery stenosis, which is carried out in the United States in more than 100,000 cases each year. What are the advantages of carotid endarterectomy? First, it is a well-established procedure that is not too difficult to perform and is highly effective. Secondly, the incision is not large and the neck incision is not aesthetically pleasing. Third, the cost is cheap, the cost of this type of surgery is roughly around 4,000-5,000 dollars, while the cost of 1 carotid stent is about 80,000 to 90,000 dollars. Fourth, it is safe and has fewer postoperative complications. It reduces the risk of cerebral infarction induced by the formation and dislodgement of small emboli due to the extrusion of plaque during the placement of stent. The risk of cerebral infarction after carotid endarterectomy is less than that of carotid stenting, as proved by evidence-based medicine. Fifthly, the procedure is highly repeatable, and patients can continue to place stents after carotid endarterectomy even if stenosis occurs again. This avoids the situation where the stent is placed first and then thrombosis occurs at the stent after the operation and nothing can be done about it. Sixth, the long-term financial burden after surgery is low. Patients do not need to take expensive antiplatelet drugs such as Polivir for a long period of time like patients with carotid stenting after this type of surgery, so the financial burden on the family is low. Recently, we have used external carotid endarterectomy to treat a case of carotid stenosis in an elderly patient, during the operation from the carotid artery stripped out about 100px size shoot plaque, after the operation, the patient did not have any complications, the symptoms of cerebral ischemia completely relieved. Carotid endarterectomy has been widely carried out in Europe and the United States and other countries, and has achieved better efficacy, and has become the first choice for the treatment of such diseases. The indications for carotid endarterectomy are broad, and carotid endarterectomy can be considered for asymptomatic carotid artery stenosis (stenosis ≥75%) or symptomatic carotid artery stenosis (stenosis ≥50%, with multiple transient cerebral ischemia or mild-to-moderate strokes within 6 months). However, in China, limited by concepts and conditions, this kind of procedure is carried out very limited. Therefore, some scholars in China believe that carotid stenting is superior to carotid endarterectomy, and we believe that this view is unfounded and biased. In this paper, we hope that through publicity and education, a wider range of patients can understand the potential hazards of carotid plaque, and choose the appropriate examination and treatment means, so as to achieve the purpose of prevention, early diagnosis and early treatment, and to avoid the occurrence of cerebral stroke. It is also hoped that through the communication between this paper and medical colleagues, a more objective and rational choice of surgical methods can be made, and more reasonable and effective treatment suggestions can be provided to patients to maximize the benefit of the patients, so as to construct a harmonious doctor-patient relationship and create a green medical environment together.