Carotid artery stenosis is a relatively common disease, with atherosclerotic stenosis being the main cause in particular. Carotid artery stenosis can cause about 20% of strokes, and the latter is the third leading factor of human death in the world today, after cardiovascular disease and tumors, posing a serious threat to human health. How can a simple arterial stenosis lead to a series of serious consequences such as hemiplegia, aphasia and blindness? Below we will unravel the mystery of carotid stenosis eating away at the lumen of the artery and whaling away at the function of the nervous system. Pathology of carotid stenosis.
1, the risk factors of carotid stenosis are divided into controllable factors and uncontrollable factors
The former include: age, gender, race, etc.; the latter include: smoking, hyperlipidemia, diabetes mellitus, hyperfibrinemia, etc. The most common cause of carotid stenosis is the formation of atherosclerotic plaques, abnormal proliferation of intima and smooth muscle cells in the arterial vessel wall due to abnormal muscle lipid metabolism, which finally leads to narrowing of the lumen diameter and even occlusion. The best site is the bifurcation of the common carotid artery, followed by the beginning of the common carotid artery, in addition to the siphon of the internal carotid artery, the middle cerebral artery and the anterior cerebral artery.
2. Carotid plaque mainly causes cerebral ischemia through the following two pathways
One way is that the severely stenosed carotid artery causes hemodynamic changes, resulting in hypoperfusion in the corresponding parts of the brain; the other way is that microemboli in the plaque or microthrombi on the surface of the plaque are dislodged to cause cerebral embolism. Clinical manifestations of carotid artery stenosis.
1, symptomatic carotid stenosis
(1) Symptoms of cerebral ischemia.
There may be tinnitus, vertigo, darkness, blurred vision, dizziness, headache, insomnia, memory loss, drowsiness, and dreaminess. Ocular ischemia manifests as vision loss, hemianopia, diplopia, etc.
(2) TIA is a transient loss of local neurological function, which is characterized by transient impairment of sensory or motor function of one limb, transient monocular blindness or aphasia, etc. It usually lasts only a few minutes and recovers completely within 24h after the onset. There is no focal lesion on imaging examination.
(3) 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.
2.Asymptomatic carotid artery stenosis
Many patients with carotid stenosis do not have any clinical signs and symptoms of the nervous system. Sometimes, only a weakened or absent carotid pulsation is detected during physical examination, and a vascular murmur is heard at the root of the neck or at the carotid meridian. Asymptomatic carotid stenosis, especially severe stenosis or plaque ulceration, is recognized as a “high-risk lesion” and is receiving increasing attention.
Treatment of carotid stenosis is aimed at improving cerebral blood supply, correcting or relieving symptoms of cerebral ischemia, and preventing TIA and ischemic stroke. Treatment is based on the degree of carotid stenosis and the patient’s symptoms, including medical, surgical and interventional treatments.
1. The purpose of conservative medical treatment is to reduce the symptoms of cerebral ischemia, reduce the risk of stroke, and control the existing diseases such as hypertension, diabetes, hyperlipidemia and coronary heart disease. Conservative medical treatment includes the following.
(1) Reducing body weight.
(2) Smoking cessation.
(3) plaque stabilization therapy.
(4) Anti-platelet aggregation therapy.
(5) Improvement of symptoms of cerebral ischemia.
(6) Regular ultrasound examination to dynamically monitor the changes of the disease.
2.Surgical treatment mainly refers to carotid endarterectomy (CEA).
It is the only method that can achieve removal of atherosclerotic plaque and reconstruction of normal lumen and blood flow. By the 1980s, many centers in Europe and the United States began to conduct systematic studies on CEA. Several multicenter randomized controlled studies with large samples have shown that CEA is significantly more effective than drug treatment for severe carotid stenosis and symptomatic moderate carotid stenosis, and now, CEA can reach 170,000 per year in North America and has become the preferred treatment option for carotid stenosis. It is the “gold standard” for the treatment of carotid stenosis in the carotid segment.
3. Interventional treatment emerged after the 1990s, and with the advancement of equipment and devices, Carotid Stenting Angioplasty (CAS) is gradually developed and popularized, and has the tendency to replace CEA. Carotid stenting is mainly based on endovascular interventional techniques, using balloons or stents to dilate the stenosis of the carotid artery, thus achieving the purpose of reestablishing carotid blood flow.
Prevention of carotid artery stenosis is as follows.
1, because the main cause of this disease is atherosclerosis, aortitis, trauma and radiation injury, so active treatment and prevention of the primary disease is the key to prevent this disease.
2.Significant carotid artery stenosis can be detected by surgical or interventional intervention to eliminate potential sources of emboli and prevent the occurrence of strokes.
3, a balanced diet, more fruits and vegetables and other high-fiber foods, more eggs, soybeans and other high-protein foods, pay attention to a light diet, you can do a moderate amount of exercise
4. Avoid smoking, alcohol, spicy food, coffee and other stimulating foods.