1, “three high” is the main cause of carotid artery stenosis Typical transient ischemic attack caused by carotid stenosis, many people may first think of stroke or eye disease, but not carotid stenosis. We all know that stroke (stroke) is one of the three major life threatening killers with high morbidity, mortality and disability rates, and about 1/3 of strokes are caused by carotid stenosis. The symptoms of the two elderly people above are danger signs of carotid artery stenosis. The brain is a special oxygen-demanding organ with a very high demand for oxygen. About one-tenth of the heart’s beat output per minute is supplied to the brain. Accordingly, brain tissue is quite sensitive to ischemia and hypoxia. In the neck, the arteries supplying blood and oxygen to our central system include a pair of carotid arteries and a pair of vertebral arteries, and two of them provide more than 80% of the blood supply to the brain tissue. Therefore, when carotid artery stenosis occurs, the blood supply to the brain is affected; if the narrowing of the lumen is caused by atherosclerotic plaque in the carotid artery lining, the occurrence of plaque detachment can also cause stroke. The main pathological mechanism of carotid stenosis is atherosclerosis, which is actually the neck manifestation of systemic atherosclerosis. Risk factors for carotid stenosis are also risk factors for important vascular diseases such as coronary heart disease. The well-known “three highs” – hypertension, hyperlipidemia and hyperglycemia – are the main causes of carotid artery stenosis. In addition, smoking, obesity, advanced age and unhealthy lifestyle habits (mental stress, lack of exercise, etc.) are also risk factors for carotid artery stenosis. The main clinical manifestation of carotid stenosis is transient ischemic attack (TIA), i.e., mini-stroke: sudden onset of dizziness, temporary darkness in one eye, numbness and weakness in arms and legs, slurred speech, weakness in 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 the decline of intelligence and social functions and other advanced intellectual activities. 3, diagnosis preferred carotid ultrasound Although carotid artery stenosis is very dangerous, the examination 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 degree of carotid stenosis, soft and hard plaques, etc. needs to be clarified, 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 plaques 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 examination. 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. 4. Carotid endarterectomy is the standard procedure In terms of treatment, the first and foremost measure is to prevent and treat the diseases that cause carotid artery stenosis, i.e., reasonable treatment of the “three highs”: control blood pressure, blood sugar and blood lipids; eat a light diet and avoid a high-salt and high-fat diet; quit smoking; develop good lifestyle habits and ensure sleep quality; strengthen exercise and Regular physical examination. However, for patients with carotid artery stenosis, there is no drug that can eliminate the plaque causing the stenosis. Carotid artery stenosis treatment is divided into three categories: medication, 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. Traditional surgical treatment, namely carotid endarterectomy (CEA), is the standard treatment for carotid artery stenosis. Numerous clinical studies have demonstrated that carotid endarterectomy is the treatment of choice for severe carotid stenosis (>70% stenosis) or carotid stenosis with “early warning” signs, and that it is valuable for stroke prevention. An experienced vascular surgeon can perform carotid endarterectomy skillfully, and the appropriate use of a diverter tube and patch can increase the safety of the procedure and improve its efficacy. In recent years, the use of carotid balloon-expandable stenting (CAS) for carotid stenosis has increased due to the development of safe and effective stent delivery and release devices and stent materials, especially the use of cerebral protection devices, which have obvious advantages: less trauma, faster recovery, and much shorter hospital stay, especially in elderly patients with cardiopulmonary vascular disease. The measure can reduce the incidence of cardiopulmonary vascular complications. Carotid artery stenosis is the “silent killer” of stroke. However, if we understand the characteristics of this “killer”, we can catch the signs of carotid stenosis in time, prevent it early, treat it in time, and nip the risk of stroke in the bud.