Surgical treatment of carotid plaque with stenosis Cerebrovascular disease is one of the three leading causes of death in humans today, with more than 2 million people dying of stroke each year. In China, there are 1.5-1.8 million new strokes and 900,000-1.1 million deaths each year, and about 75% of the survivors are disabled. Among cerebrovascular accidents, ischemic strokes such as cerebral ischemia and cerebral infarction account for 75%-90% of strokes, and carotid plaque with stenosis is the main cause of ischemic strokes. The prevention of ischemic stroke is usually treated with medication and surgery. In patients with more than 70% stenosis due to carotid plaque or 50% stenosis with clinical symptoms, the effect of drug therapy alone is limited and surgical treatment should be considered, which includes both carotid endarterectomy (CEA) and endovascular stenting (CAS). In 1954, Eastcott performed the first carotid artery endarterectomy (CEA), which allowed complete removal of the atheromatous plaque causing carotid stenosis, effectively restoring carotid blood flow and preventing stroke, and with minimal recurrence of plaque due to complete endarterectomy. It has been considered the “gold standard” procedure for the treatment of carotid plaque with stenosis and stroke prevention for many years. Currently, approximately 150,000 people across the United States undergo carotid endarterectomy each year. In 1994, Market and Mathias et al. first reported carotid artery stenting (CAS) for the treatment of carotid plaque with stenosis. The procedure is performed without a neck incision and has a shorter operative time and faster recovery, but it is potentially more risky, with the risk of cerebral infarction due to microemboli dislodged during stent placement. Treatment. Due to the reduced coagulation function, cerebral hemorrhage in case of rupture of hardened cerebral arteries may lead to catastrophic consequences that cannot be saved; high treatment costs and high out-of-pocket expenses. With the advancement of vascular interventional materials and technology, carotid stenting has become another challenging and important treatment for carotid stenosis in recent years. There has been academic controversy as to whether the two techniques are superior or inferior. McPhee in 2007 summarized the clinical data of 259080 patients who underwent carotid stenting and carotid endarterectomy in the United States between 2003 and 2004 and found that the complication and mortality rates were significantly higher with carotid stenting than with carotid endarterectomy. A study of 12,400 patients in 2005 reported by Mohammad H. Eslami in June 2008 showed that patients who underwent carotid stenting had a higher risk of postoperative stroke than those who underwent carotid endarterectomy. Hospital mortality was also five times higher; hospitalization costs were significantly higher than for patients with symptomatic carotid stenosis in particular; and long-term anticoagulant therapy was also required after hospital discharge. Steinbauer MG of the Department of Vascular and Endovascular Surgery at the University of Regensburg, Germany, published the results of his single-center prospective randomized controlled study in the American Journal of Vascular Surgery in July 2008, showing that carotid endarterectomy had significantly better long-term follow-up results than carotid stenting. In fact, both treatment methods have their scientific validity and rationality, and each has its own advantages and disadvantages. It is not necessary to overly investigate which surgical approach is better or worse, i.e., the surgical strategy determines the surgical outcome rather than the surgical technique and skill itself. In clinical work, all factors should be considered comprehensively, and the indications for treatment should be strictly grasped to choose the most suitable individualized treatment for the patient. China has a large population base and a large number of cases of carotid plaque with stenosis. Hundreds of thousands of people in Europe and the United States undergo carotid endarterectomy each year, while the total number of cases undergoing carotid endarterectomy in China is less than 1000 each year. At present, the treatment of carotid plaque with stenosis in China is mainly based on carotid stenting, which is completely contrary to the “gold standard” surgical treatment program recommended by domestic and international experts. The reasons for this are mainly related to the fact that most of the patients with carotid stenosis are admitted to medical wards, the lack of promotion of carotid endarterectomy by surgeons and other social factors. Our hospital is the base hospital of the Stroke Screening and Prevention Project Committee of the Ministry of Health, and our department is a national key clinical specialty. In 2011, he went to Xuanwu Hospital of Capital Medical University to study the surgical treatment of carotid plaque with stenosis (including CEA and CAS), under the supervision of Professor Jiao Liqun, one of the most famous experts in this field in China, and laid a solid foundation for the development of both procedures, which are now carried out in our department. Our department is making efforts to promote the prevention of cerebrovascular diseases, informing patients of the dangers of carotid plaque with stenosis, advising them to remove the “garbage” in the carotid vessels as early as possible to reduce the risk of cerebral infarction, so as to avoid losing the best time for treatment after a serious stroke (stroke).