Carotid artery is one of the main blood vessels supplying blood to the cranium, so carotid stenosis is directly related to ischemic stroke. More than 60% of cerebral infarction is caused by carotid stenosis, and severe cerebral infarction can lead to disability or even death. Therefore, carotid artery stenosis has become one of the “number one killers” of people’s health in today’s society. Therefore, it is important to treat carotid stenosis and prevent stroke.
There are many causes of carotid artery stenosis, including atherosclerosis, carotid artery entrapment, developmental, inflammatory or autoimmune vascular lesions, such as aortitis, fibromuscular dysplasia, and smog. Among this group of patients, a larger proportion of young patients.
Clinical manifestations
Some patients with mild to moderate carotid artery stenosis may have no clinical symptoms. For those with clinical symptoms associated with stenosis, it is called “symptomatic carotid stenosis”. The clinical manifestations of symptomatic carotid stenosis mainly include cerebral ischemic symptoms: tinnitus, vertigo, blackness, blurred vision, dizziness, headache, insomnia, memory loss, drowsiness, and dreaminess. Ocular ischemia manifests as decreased visual acuity, hemianopia, diplopia, etc. Localized transient loss of neurological function in TIA is clinically manifested by transient impairment of sensory or motor function of one limb, transient monocular blindness or aphasia, etc., which usually lasts only a few minutes and recovers completely within 24 h after onset. There are no focal lesions on imaging. 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.
Vascular imaging methods
At present, the main vascular imaging methods applied to carotid arteries include carotid ultrasound, transcranial color Doppler, CT angiography (CTA), and digital subtraction angiography (DSA). Among them, DSA is the “gold standard” of examination. For ischemic changes in brain tissue caused by carotid stenosis, the main brain tissue examinations currently used in clinical practice are computed tomography (CT) and magnetic resonance imaging (MRI), including MRI scan, MRA, DWI and PWI.
In addition, there are also MRI-based methods for plaque characterization, which mainly refer to multi-sequence MRI, using the sensitivity of different MRI scans for different tissues to detect the main component characteristics of plaque.
Diagnosis
The diagnosis of carotid artery stenosis is based on clinical symptoms, physical examination and imaging. At present, the main imaging methods used in clinical practice include morphological examination of blood vessels and examination of brain tissues, while imaging studies on the nature of plaque and blood rheology are the future research direction.
Differential diagnosis
The differential diagnosis of carotid artery stenosis mainly includes the differentiation of symptoms and the differentiation of sites. Symptoms are mainly related to other intracerebral lesions such as intracranial occupations, seizures, and other cerebrovascular diseases. The locational differentiation refers to whether the carotid stenosis is the “responsible vessel” for the ischemia of the brain tissue when combined with other vascular stenosis diseases.
Treatment
Treatment of carotid artery stenosis mainly includes risk factor control, medication, surgery and interventional treatment.
The control of risk factors mainly includes: proper exercise, weight control, avoiding obesity, quitting smoking, reducing alcohol consumption, and reasonable control of blood pressure, blood sugar, and blood lipids.
2.Medication
Drug treatment mainly includes stabilization of atherosclerotic plaque and anti-platelet aggregation drugs. Statins, aspirin and/or clopidogrel are commonly used in clinical practice to regulate lipids. In addition, pharmacotherapy includes medications for risk factors such as hypertension and diabetes mellitus. Drug therapy can only stabilize atherosclerotic plaques, minimize thrombosis and slow down the progression of atherosclerosis, thus reducing the occurrence of cerebral ischemic events, and cannot fundamentally remove plaques or restore blood flow to brain tissue.
3.Surgical treatment
Surgical treatment mainly refers to carotid endarterectomy (CEA). It is the only method that can remove the atherosclerotic plaque and reconstruct the normal lumen and blood flow. Currently, the Medical Secretary of the State Council of Europe, America and China recommends CEA surgery as the first choice for carotid artery stenosis. It is the “gold standard” for the treatment of carotid stenosis in the carotid segment.
4.Interventional treatment
Carotid artery stenting is mainly based on endovascular interventional techniques, using balloons or stents to expand the stenosis of the carotid artery, so as to achieve the purpose of reestablishing carotid artery blood flow. The European and American countries believe that CAS can achieve similar or even better results in special populations. In China, the Chief Medical Officer explicitly states that CAS can be considered for patients who are unable to undergo CEA after consultation with a vascular or neurosurgical specialist.