In China, carotid vascular color Doppler ultrasound has become popular in hospitals at the county and rural levels. As one of the most convenient means of screening risk factors for cerebrovascular disease, carotid ultrasound is not only a mandatory item in all kinds of medical examination packages, but also a routine examination in neurology. As a result, “carotid atherosclerotic plaque” is like fallen leaves in autumn and can be seen everywhere. 1, what is atherosclerosis So we have to talk about atherosclerosis. Atherosclerosis is a layer of waxy lipids deposited on the walls of the arteries, making the arteries less elastic and narrowing the lumen of the lesions. When these waxy deposits form one by one, they are called atherosclerotic plaques. These plaques are flush with the intima of the blood vessels in the early stage and usually follow the longitudinal distribution of the vessels. Then, if they continue to progress, the plaques slowly protrude inward in the walls of the vessels, causing different degrees of narrowing of the inner diameter of the arteries. Usually, the atherosclerotic plaque in a person’s carotid artery starts to develop from adolescence (around 15 years old) and becomes obvious around the age of 40, and by the age of 60, there are only a few people who have not found a single atherosclerotic plaque in their carotid artery. 2.Why does carotid atherosclerotic plaque occur? High blood pressure is an important factor that promotes the occurrence and development of atherosclerosis. High blood pressure causes blood to impact the intima, resulting in thickening of the wall and thinning of the lumen. Damage to the lining of the vessel wall can easily lead to cholesterol and lipid deposition and aggravate the formation of atherosclerotic plaque. Therefore, hypertension is a risk factor for atherosclerosis. There are plaque formation on the vessel wall in the neck, in the lateral wall at the bifurcation of the carotid artery and the medial wall at the bend and the carotid sinus. The blood in these areas is affected by the angle of the vessel to form a non-laminar flow state such as turbulence, thus making it easy for the intima to be damaged, which is conducive to lipid deposition and platelet aggregation to form atheromatous lesions. The next factors that tend to trigger the formation of carotid atherosclerotic plaques include: aging, smoking, abnormal lipids, especially elevated low-density lipoprotein cholesterol (LDL-C), abnormally elevated blood sugar, lack of exercise, frequent inflammation in the body, elevated homocysteine, and unhealthy diet. These factors will accelerate the development of atherosclerotic plaques or appear in advance, and will also make more atherosclerotic plaques “volcanic eruption”, inducing cerebrovascular diseases, therefore, good control of these factors can in turn treat and delay the occurrence and development of carotid atherosclerosis. 3.Is carotid atherosclerosis plaque formation dangerous? The words “carotid plaque formation” will appear more or less in the medical examination reports of middle-aged and elderly people over 40 years old. What do you think about this kind of test result? We caution that it is not necessary to talk about plaque formation, but should be treated scientifically. First of all, you should pay attention to whether the atherosclerotic plaque protrudes from the vessel wall or not. If it does not, then you can be quite relieved because, as mentioned above, this is the early stage of atherosclerotic plaque formation. If it is protruding from the vessel wall, then the ultrasonographer will usually report changes in the blood flow spectrum at the plaque, which may reflect a narrowing of the vessel lumen, and if this suggests a narrowing of the lumen, the physician will need to perform other forms of testing such as CTA or DSA to clarify the specifics of the lesion. Of course, this determination should be made by your physician. 4.How to treat carotid atherosclerotic plaque Prevention includes adjusting life and diet, participating in fitness activities, abstaining from smoking and limiting alcohol, reducing blood viscosity, lowering blood lipids, controlling good blood pressure, not smoking and so on. Not all carotid atherosclerotic plaques must be treated with drugs. For example, a 60-year-old person who is in good health (meaning he is a non-smoker, has a healthy lifestyle, no hypertension or diabetes, and no other risk factors for stroke) and has a hypoechoic plaque of 11.4mm*2.7mm in size in the sinus of the right common carotid artery with normal flow signal and an intima-media thickness of 0.87mm does not need to be treated with medication. In contrast, when the carotid atherosclerotic plaque grows to a certain extent and begins to affect the blood flow in the carotid artery, it must be evaluated and treated accordingly to prevent a vascular event. Usually, aggressive treatment is warranted when plaque growth results in luminal narrowing of more than 70% or when, although the stenosis is not severe, the plaque is an unstable plaque. Severe carotid stenosis usually has some non-specific symptoms such as dizziness, dullness and sometimes transient ischemic attacks or even strokes. The treatment is divided into two aspects: on the one hand, medication, such as antiplatelet drugs and statins, which are the mainstay of treatment for carotid atherosclerosis; on the other hand, carotid endarterectomy (CEA, a surgical procedure to remove atherosclerotic plaque from the blood vessels) or carotid stenting (a method of stenting the narrowed artery through endovascular intervention). In addition, some drugs that activate blood circulation and remove blood stasis and antioxidants are useful for the treatment of carotid atherosclerosis. A varied dietary structure, moderate consumption of virgin olive oil, and a high intake of fresh fruits and vegetables also have a good effect on softening blood vessels. Salmon, tuna, sardines, swordfish, etc. contain more Omega-3, which can assist in softening blood vessels. This shows how important a good lifestyle and a healthy diet are for the prevention and treatment of carotid atherosclerosis.