Old Ren, 72 years old, is a retired teacher of a university in our province. In recent years, he often experienced dizziness, tinnitus, sometimes blurred vision, and even sudden blackness in front of his eyes. One day not long ago, when he got up in the morning, he suddenly fell down and lost consciousness, but woke up a few minutes later on his own, without any discomfort. The doctors successfully performed an external carotid endarterectomy in just over an hour, removing two thumb-sized plaques and restoring the blood supply to the brain. He was discharged from the hospital a week later. Before he was discharged from the hospital, he used his personal experience to warn all patients that they should check their carotid arteries as soon as possible after the symptoms of dizziness, tinnitus and blurred vision appear, otherwise they will regret their lives if they delay their illness! According to the report of the World Health Organization, stroke is the 3rd cause of death worldwide after coronary heart disease and cancer. The incidence and mortality rate of stroke in China is much higher than in Europe and the United States, and statistics show that the annual direct economic expenditure on stroke in China is nearly 30 billion yuan, which not only endangers people’s health, but also brings a serious economic burden to families and society. The vast majority of strokes are triggered by cerebrovascular ischemia, of which about 40% are related to extracranial segment carotid artery sclerosis stenosis or even occlusive lesions.” Recently, the reporter was informed in an interview with Professor Zhou Tao of the Peripheral Vascular Department of the First Affiliated Hospital of Henan College of Traditional Chinese Medicine. What clinical symptoms can be produced by carotid stenosis? The main clinical manifestation of carotid stenosis is transient ischemic attack (TIA), i.e. mini-stroke: sudden onset of dizziness, temporary blackness of one eye, slurred speech, or weakness of one limb, unstable holding, crooked mouth, etc., often recovering within 24 hours. These manifestations are caused by the dislodgement of small carotid atherosclerotic plaques, resulting in the embolization of small intracranial arteries, and are important warning signs. If the dislodgement of larger plaques continues to occur, resulting in embolization of relatively large intracranial arteries, it can lead to acute cerebral infarction, causing permanent hemiparesis, hemianesthesia, hemianopia and speech dysfunction. In addition, because carotid stenosis can lead to insufficient blood supply to the brain, prolonged cerebral ischemia can cause chronic brain damage, which can cause symptoms such as dizziness and vision loss, and even lead to a decline in higher intellectual activities such as intelligence and social function. Although carotid artery stenosis is very dangerous, the means to diagnose carotid artery stenosis is very simple, which can be achieved by carotid ultrasound. Of course, for further surgical treatment, detailed information on the site, length, and extent of carotid stenosis, soft and hard plaques, etc. is needed, and we can choose carotid angiography (DSA). The advantage of angiography is that it has high spatial resolution and can accurately examine the degree and extent of arterial stenosis, including the distribution of plaque and ulcers, as well as show the blood flow in the distal part of the stenosis and the establishment of collateral circulation, and show whether intracranial vascular lesions occur, making it the gold standard for diagnosing arterial lesions. However, angiography is an invasive test, and in recent years, the application of non-invasive CT arterial reconstruction (CTA) and MRA techniques can also obtain very comprehensive information on arterial stenosis; at the same time, it can show the vascular structure from different angles, better identify calcified plaques, and guide further treatment. Carotid artery stenosis treatment is currently divided into three broad categories: pharmacological treatment, surgical treatment, and interventional treatment. Drug therapy is mainly antiplatelet therapy, combined with antihypertensive, lipid-lowering and glucose-lowering drugs, which can slow down the development of atherosclerotic stenosis and occlusion, but there is no drug that can eliminate the plaque that causes arterial stenosis. In recent years, interventional treatment, namely carotid artery angioplasty and stenting (CAS), has been developing rapidly, but most of the completed clinical trials have shown that the safety and effectiveness of interventional treatment are not superior to surgery except for high-risk patients, and the “guidelines” or “expert consensus documents” recently published in the United States, Europe, and Australia clearly indicate that interventional treatment is not superior to surgery. The “guidelines” or “expert consensus documents” recently published in the United States, Europe, and Australia clearly state that ≥50% of symptomatic carotid stenoses are suitable for surgical treatment, while interventional therapy (CAS) is only indicated for patients who are not suitable for surgical procedures. Surgical treatment, namely carotid endarterectomy (CEA), is the standard treatment for carotid artery stenosis and stroke prevention. This procedure involves the removal of atherosclerotic plaque and thrombus formed on the intima of the artery to open the blood vessels and restore blood supply. In particular, two large randomized controlled trials in the late 1980s in several Western countries have shown that carotid endarterectomy can prevent cerebral infarction and death due to arterial lesions. Currently, 100,000 endarterectomies are performed each year in the United States. In contrast, less than 1,000 cases are performed each year in China’s population of 1.3 billion. With the gradual improvement of living standards, people have higher requirements for quality of life, so carotid endarterectomy will be more and more accepted by people. Director Zhou Tao finally pointed out that carotid artery stenosis is the “silent killer” that causes stroke. However, as long as we understand the characteristics of this “killer”, we can catch the traces of carotid stenosis in time, early prevention, timely treatment, to eliminate the risk of stroke in the bud. (Dahe Newspaper)