Carotid endarterectomy (CEA), a method of removing thickened carotid intima-media atherosclerotic plaques to prevent stroke due to plaque blockage or dislodgement of the carotid artery, has proven to be an effective method for preventing and treating ischemic cerebrovascular disease. CEA, which has been performed abroad for 50 years, is a sparing procedure that shifts the focus of attention to cerebrovascular disease forward to prevent cerebral infarction. I. Pathogenesis The most important causes of ischemic stroke are atherosclerosis, aortitis, trauma and radiation injury. Atherosclerosis is the most common cause of carotid plaque in middle-aged and elderly patients. Patients are often accompanied by other risk factors that predispose to cardiovascular damage, such as hypertension, heart disease, diabetes, hyperlipidemia, obesity, smoking, etc. Recent studies have shown that hyperuricemia is also an independent risk factor for stroke. The best site for carotid plaque is the bifurcation of the common carotid artery, followed by the beginning of the common carotid artery, the siphon of the internal carotid artery, the middle cerebral artery and the anterior cerebral artery. It is generally believed that carotid plaque causes cerebral ischemia mainly through the following three ways: one way is that the severely narrowed carotid artery causes hemodynamic changes, resulting in hypoperfusion of the corresponding parts of the brain; another way is that microemboli in the plaque or microthrombi on the surface of the plaque are dislodged to cause cerebral embolism; thirdly, based on the rupture of the plaque, the body will have a response to repair the damage, and platelets that help clotting will gather locally, leading to the formation of large internal carotid artery plaques. This leads to the formation of large thrombus in the internal carotid artery, which slows down the blood flow or completely occludes it and produces cerebral blood supply disorder. Clinical manifestations 1. Asymptomatic carotid stenosis: Many patients with carotid plaque do not have any neurological symptoms and signs clinically. Sometimes, only weakened or absent carotid artery pulsation is found during physical examination, and vascular murmurs are heard at the root of the neck or at the carotid artery meridian. Asymptomatic carotid plaques, especially severe plaques or plaque ulcers, are recognized as “high-risk lesions” and are receiving more and more attention. Symptomatic carotid stenosis: cerebral ischemic symptoms: tinnitus, dizziness, blackness, blurred vision, dizziness, headache, insomnia, memory loss, drowsiness, dreaminess and other symptoms. The localized transient loss of neurological function in TIA is characterized by transient impairment of sensory or motor function of one limb, transient monocular blindness or aphasia, which usually lasts only a few minutes and recovers completely within 24 h after the onset. There are no focal lesions on imaging. 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. Non-invasive examinations: ultrasound, CTA and (MRA). Invasive examinations: DSA. 1. Ultrasonography of the blood supply arteries Combined B-mode ultrasonography and transcranial Doppler examination to detect stenosis of the blood supply arteries, of which transcranial Doppler is the most widely used noninvasive method to detect stenosis of the blood supply arteries. The degree of carotid artery stenosis. 2. CT angiography (CTA) is used to find out the presence of stenosis and calcified plaque in the extracranial segment of the carotid artery system, as well as its degree and extent. If ultrasonography is not sure, CTA can be performed as a supplement, which can accurately show the diameter of the vessel lumen and maximize the differentiation between the vessel wall, lumen and soft tissue or calcified plaque. 3. Magnetic resonance angiography MRA: No contrast agent is needed, and vascular imaging can be performed mainly by the mobility of blood, which is a non-invasive examination method. 4. Cerebral angiography (DSA): Cerebral angiography is the “gold standard” for evaluating cerebral blood vessels, but it is an invasive test and not the preferred test method. When ultrasound, CTA, TCD, MRA and other examinations suspect cerebral vascular stenosis (especially intracranial cerebral vascular stenosis), catheter angiography is necessary for a clear diagnosis. This kind of examination can provide a dynamic and comprehensive view of the blood flow, variation, side branch compensation and the integrity of the Willis loop in the cerebral vessels. V. Treatment: The most authoritative data released by the National Brain Prevention Committee, “China Stroke Prevention and Control Report 2015”, shows that stroke is the first cause of death in China, and the prevalence is on the rise, with urban than rural areas; the economic burden of stroke to China is up to 40 billion yuan per year. China has entered an aging society, and if a large number of middle-aged people die early or become disabled due to stroke, the first chronic disease that will occur in China is stroke, if not controlled! The WHO estimates that the number of stroke deaths in China will reach 4 million per year in 2030 based on the current incidence of stroke, and that 50-75% of people with cerebrovascular disease will lose their workforce once they develop. Therefore, it is urgent to screen and intervene in middle-aged people for stroke risk as soon as possible. Refer to the guideline specification for carotid endarterectomy in China CEA procedure indications: 1. Asymptomatic patients: Asymptomatic patients with carotid stenosis greater than 70% and perioperative stroke or mortality should be less than 3%. 2. Symptomatic patients: patients with non-disabling ischemic stroke or transient cerebral ischemia within 6 months, with low to moderate risk of surgery; non-invasive imaging confirmed carotid stenosis greater than 70%, or angiographic findings of stenosis greater than 50%, and perioperative stroke or mortality should be less than 6%. Compared with traditional carotid endarterectomy performed with bare eyes, the advantages of neurosurgical microscopic carotid endarterectomy are as follows: 1.Provide more ideal light source and illumination, especially for deep illumination of high lesions; 2.The relationship between the layers of the arterial wall and the plaque can be clearly distinguished under the microscope, making the separation very clear and easy; 3.The distal endothelium of the internal carotid artery can be handled more delicately, clearly distinguishing between the plaque 3. The distal endothelium of the internal carotid artery can be treated more delicately to clearly distinguish between plaque and normal endothelial migration, which reduces the possibility of postoperative thrombosis and entrapment; 4. The stitch distance is smaller and the suture is more meticulous, which prevents the outer membrane tissue from being brought into the anastomotic margin and reduces the possibility of postoperative thrombosis and long-term restenosis. As one of the 300 stroke screening bases in China, our hospital carries out carotid endarterectomy with important social and economic benefits. Under the high priority of the hospital leadership, the key staff of our department has been selected for specialty-specific training and a CEA surgical treatment team has been established, and the first carotid artery dissection surgery in Nanyang City has been successfully carried out with good results. Carotid artery endothelial debridement The 7 cm long carotid plaque has almost completely blocked the lumen of carotid artery, and the atheromatous plaque is in danger of falling off at any time.