Ischemic stroke is an acute cerebrovascular disease characterized by high morbidity, disability and mortality. Ischemic stroke can be classified into transient ischemic attack, reversible ischemic neurological dysfunction, and cerebral infarction according to its severity. Severe ischemic stroke can lead to symptoms such as hemiparesis, hemiplegia, hemiplegia, aphasia, coma, and even cause death. Carotid artery stenosis is the main cause of ischemic stroke. Carotid endarterectomy has become the gold standard for prevention of cerebral infarction by removing atherosclerotic plaques in the carotid artery, and the surgery has become very mature. Sun Jinlong, Department of Neurosurgery, Qianfoshan Hospital, Shandong Province 1. Incidence of ischemic stroke: China has 1.2 million to 1.5 million new stroke patients every year, and 800,000 to 1 million deaths. In the United States, 500,000 people develop the disease every year, of which 150,000 die and more than 2 million people need medical care. Among new stroke patients, ischemic stroke accounts for 75%~90%. 2. The main causes of ischemic stroke: ① carotid artery stenosis is the main cause of ischemic stroke, the most common cause of carotid artery stenosis is due to the formation of atherosclerotic plaques in the arterial vessel wall, endothelial and smooth muscle cells abnormal proliferation, resulting in narrowing of the lumen diameter of the vessel, or even occlusion. ② cardiac embolism: due to cardiac embolism through the circulatory system to the cerebrovascular embolism, causing cerebral dysfunction in the corresponding blood supply area. Intracranial vascular amyloidosis. 3. Clinical manifestations of carotid stenosis: ① light without any discomfort or only tinnitus, blurred vision, headache, dizziness, memory loss, fatigue, drowsiness, insomnia, sleeplessness, dreams and other manifestations. Transient ischemic attack (TIA) can be caused by transient cerebral insufficiency of blood supply and micro-arterial infarction. The symptoms of TIA include episodic numbness, weakness of upper or lower limbs, facial paralysis, and sudden blackout in one eye, etc. The symptoms will disappear completely within 24 hours without any positive signs. ③ Reversible neurological dysfunction: the neurological dysfunction is mild and usually recovers completely within 1~3 weeks. (iv) Cerebral infarction: stroke symptoms gradually develop, hemiparesis, aphasia, seizures, and even loss of consciousness and even life-threatening. 4. Carotid artery stenosis related examination ①Carotid artery ultrasonography: it can measure the diameter and thickness of the carotid artery, determine whether there is carotid artery stenosis and the degree of stenosis, as well as whether there are intima-media plaques and ulcers. ② CT, magnetic resonance carotid angiography: this method is accurate, intuitive, reliable, painless, and a reliable non-invasive examination of carotid artery stenosis; ③ carotid angiography: the gold standard for diagnosing carotid artery stenosis and plaque formation, but the disadvantage of invasive examination, there are a variety of risks, such as plaque dislodgement. CT, magnetic resonance carotid angiography plus ultrasound can accurately detect more than 95% of patients with high risk of carotid artery stenosis. 5. Treatment of carotid atherosclerotic stenosis ① medication ② carotid endarterectomy ③ carotid stenting After a number of large-scale clinical trials in Europe and the United States have fully confirmed that: carotid endarterectomy is effective in preventing stroke, reduce mortality, is the gold standard for the treatment of symptomatic carotid artery stenosis. 6. Indications for carotid endarterectomy ① Patients who have had transient ischemic attack (TIA) or ischemic stroke within 6 months, and the stenosis of the carotid artery on the same side is more than 50%. Patients with >70% stenosis and asymptomatic carotid artery stenosis. 7. Therapeutic effect of carotid endarterectomy Carotid endarterectomy has a history of more than 50 years. In Europe and the United States, carotid endarterectomy has become a routine treatment for carotid artery stenosis, carotid artery stenosis of more than 70% of people with carotid artery endarterectomy treatment, the proportion of stroke than the simple drug prevention decreased by about 2/3. At present, domestic and foreign consensus: carotid endarterectomy is the gold standard for the treatment of carotid artery stenosis. Typical case: The patient was a 56-year-old male with episodes of limb weakness for 4 months, and a cranial CTA showed that the stenosis of the left internal carotid artery was greater than 90%. He underwent endarterectomy of the left internal carotid artery in the neurosurgery department of our hospital, and recovered well after the operation, and his symptoms disappeared. Repeat carotid CTA examination showed good recanalization (Figure). Preoperative (arrows show) Postoperative (arrows show thick stenosis) shows clear lumen) Atherosclerotic plaque was removed from the carotid artery during the operation.