Every day in the clinic, I always see patients with the results of carotid ultrasound who are worried and ask for an additional number, saying: “Doctor, can you add a number for me, I have a plaque, am I going to be paralyzed or have a brain infarction? Every day, we face this kind of question countless times. Whenever this happens, I usually ask the patient about his condition first, if he has not had any cardiovascular disease, nor hypertension, diabetes, long-term heavy smoking, alcohol consumption and family history of cerebrovascular disease, and if his blood lipids are not high, I usually tell the patient not to worry too much. We cannot say that a person is abnormal because he has grown a few gray hairs! So instead of worrying about the plaque or taking some medication for it, it is better to be happy with it for a while. Of course, not all plaques are good companions and there may be some plaques that need some intervention. Having said that, what exactly is this plaque? In fact, the main component of plaque is LDL cholesterol, which is a kind of blood lipid. Under some risk factors, such as high blood pressure, smoking, etc. that can lead to persecution of vascular endothelial cells, LDL cholesterol starts to deposit on the vascular wall, and with continuous deposition, what we call plaque will appear. Here is just a brief description of plaque, in fact, it takes a very long time from the beginning of cholesterol deposition to the final formation of plaque, before the formation of plaque, we can also see such a result on the ultrasound report: thickening of the intima media, in fact, the thickening of the intima media and plaque is a continuous process, when the intima media is between 1 mm and 1.5 mm, we call it thickening of the intima media, and When it is more than 1.5 mm, we call it plaque. In the early stage of plaque formation, it does not cause obvious stenosis, but if the plaque grows gradually, it may lead to stenosis, and when the stenosis reaches more serious, such as 70% or more stenosis, it may cause cerebral infarction, and, as the stenosis increases, the plaque may break away from its adherent vessel wall and block a vessel in the brain with blood flow, and this situation may also cause a clinical cerebral infarction event. Therefore, the most important question of whether plaque can lead to cerebral infarction is whether it leads to local stenosis, and the risk of cerebral infarction is indeed very high when there is severe stenosis. At this time, some necessary medication is definitely needed, and sometimes, surgical treatment such as putting in a stent or cutting out the plaque may also be required. When there is only plaque but no stenosis, the risk of cerebral infarction is relatively low, so there is no need to worry about it at all. At this time, some people may ask, although there is no stenosis in the plaque, but it is often said on TV or online that if the plaque is soft, it is also easy to have brain infarction, and if it is hard, it is fine. This statement is half right and half wrong. First of all, we now often make plaques as stable plaques or unstable plaques, and stable plaques may correspond to hard plaques and unstable plaques may correspond to soft plaques (note, it is possible!) . Unstable plaques, as the name implies, may lead to clinical events. Secondly, ultrasound is not the most accurate in the evaluation of stable and unstable plaques, that is, it is very difficult to define a plaque as stable or unstable simply from the ultrasound results! The ultrasound result can only be a reference, for example, if the ultrasound report has inhomogeneous echoes or multiple plaques, it is more unstable than homogeneous echoes and single plaques, but it does not necessarily mean that it is unstable. Secondly, another issue is that the stability of plaque is obviously related to whether the vessel is stenotic or not, the more stenotic the vessel is, the more its plaque may tend to be unstable. So, the most important thing, still, is whether the plaque causes the stenosis of the vessel!!! Turning to the issue of treatment, some people say that this is an era of universal statins, and everyone is taking statins. A statin, is a drug that lowers LDL cholesterol, and as new statins continue to appear, statins have fewer side effects, so it is not impossible to take an oral statin, in the absence of side effects. It is also true that in outpatient clinics, it is often encountered that patients with little or mild plaque are also taking statins. There is no unanimous opinion in the industry on this issue. Whether or not to take a statin depends on the risk of cardiovascular disease, such as whether the patient has already had a heart attack or cerebral infarction, whether the blood lipids are high, whether there is a family history of heart attack or cerebral infarction, whether the patient has hypertension, diabetes, smoking, and other factors. If there are many factors, it is reasonable to take a statin, but on the contrary, it can be temporarily not used, after all, drugs have side effects, especially in the elderly. At this time, good diet control and physical exercise may be the best treatment. After so much rambling, briefly summarize our plaque: one, first of all, see if there is stenosis, especially more than 70% stenosis, if not, two, see if the echo is heterogeneous, if not, three, see if it is multiple, if not, four, see if there is heart attack, brain attack, hypertension, family history and other factors, if not, five, physical exercise, reduce high fat diet, happy and healthy life! Finally, it is not recommended to do carotid ultrasound when there are no symptoms, it is not taboo, but there is no need to add burden to yourself.