The vast majority of blood to the brain comes from the carotid arteries. Atherosclerosis is the main culprit of carotid artery stenosis. The surface of atheromatous plaque is a layer of fibrous cap, and in the middle is cholesterol crystals and necrotic material. After the formation of atherosclerosis, the plaque grows bigger and bigger, and finally the fibrous cap ruptures, and the plaque becomes an active volcano, with debris continuously ejecting outward. The surface of the ruptured fibrous cap is very prone to thrombosis and is easily dislodged by the impact of blood flow. So what is the relationship between carotid stenosis and mini-stroke? Stroke was long thought to be caused by a problem with a blood vessel inside the brain, but more than 50 years ago, the medical community began to recognize the close link between carotid stenosis and stroke. When a stenosis occurs in the carotid artery, a significant number of patients experience a mini-stroke. At first, scientists believed that the stenosis caused a lack of blood supply to the brain that led to a mini-stroke, and naturally, the degree of stenosis became the main indicator of whether treatment was needed. Research over the last 10 years or so has shown that the blood supply to the brain on the side of the stenosis can be compensated by the opposite side of the brain, and that stenosis alone does not cause a mini-stroke; debris and surface thrombi that fall off at the atheromatous plaque follow the direction of blood flow and rush to the internal cerebral arteries and block at vessels of similar diameter to them, leading to cerebral infarction and causing a mini-stroke. For these plaques that are prone to fall off thrombus or debris, the medical community calls them unstable plaques, and conversely, plaques with smooth surfaces and no debris or thrombus loss are called stable plaques. Since the ophthalmic artery is a branch of the carotid artery, when these debris fall into the ophthalmic artery, the patient shows unilateral blackness in front of the eyes; if the debris causes blockage of the blood vessels in the speech center, the patient will have slurred speech; if the debris falls into the motor center, it will lead to weakness of the opposite limb; when it falls into the sensory center, it will cause numbness of the opposite limb. The rougher the surface of the plaque, the easier it is to form blood clots; the more unstable the plaque is, the easier it is to have debris fall out, the more likely it is to cause brain infarction, the more obvious the stroke symptoms are, and the more serious the consequences are. When a large enough debris or thrombus is dislodged from a carotid stenosis, it can lead to a serious stroke such as hemiplegia. Carotid artery stenosis is mainly caused by “3 highs, 1 smoke, 1 low”, “3 highs” refers to “high blood pressure, high blood lipids, high blood sugar”, “1 smoke “That is, smoking, “1 low” is the lack of exercise. With the improvement of people’s living standards, the incidence of the “3 highs” has increased in recent years, as a result of each other, promoting each other, smoking and lack of exercise is increasing the danger of the “3 highs”, people with these risk factors are very vulnerable to carotid artery stenosis. Carotid artery stenosis has serious consequences, so if symptoms of mini-stroke appear, you should go to a hospital vascular surgery or neurology department in time. The degree of carotid artery stenosis and its stability are mainly based on imaging examinations, including ultrasound, CTA (CT angiography), MRA (magnetic resonance angiography) and DSA (angiography). One of the feasible methods is to understand the uniformity of plaque texture by ultrasound; the other is to observe whether there are filling defects and niche shadows (i.e. surface pits) on the plaque surface by DSA. In general, color ultrasound is simple and easy to perform, and it is often used for screening in outpatient clinics. DSA findings are the most accurate, but because of the trauma involved, it is usually applied only before surgery. For elderly patients or those with the above risk factors, the carotid artery should be routinely checked during physical examinations for early diagnosis and treatment. Treatment of carotid stenosis includes surgical treatment, medication and general treatment. The two main types of surgical treatment are carotid endarterectomy and carotid stenting. The former uses an open incision to cut the carotid artery and peel off the plaque in the carotid artery; the latter uses an interventional method, using a balloon to dilate the stenosis and a stent to affix the plaque, together to restore blood flow and remove the lesion. Whether to operate or not needs to be considered based on various factors such as the presence of previous symptoms of mini-stroke, whether the plaque is stable, the degree of stenosis and the patient’s condition, etc. A professional vascular surgery specialist can make a correct judgment. Drug treatment includes taking anti-platelet aggregation drugs and statins. The commonly used anti-platelet aggregation drugs are aspirin and Bolivar, which are applied to prevent thrombosis on the plaque surface. Once carotid artery stenosis is detected, statins should be taken regardless of the presence of dyslipidemia. At present, the commonly used drugs include Lipitor, Sulforaphane and Prasugol. Drug therapy is both the basis of non-surgical treatment and an important element in maintaining long-term therapeutic effects after surgery. General treatment is the basis of drug and surgical treatment. It includes blood glucose control, lipid control, blood pressure control, uric acid control, immediate cessation of smoking and reduction of alcohol consumption. Diet is also an important aspect in the prevention and control of carotid stenosis. Diet adjustment includes two aspects: 1. It is to talk about the diet and prevent excessive intake of oil, salt and sugar; 2. It is to limit calorie intake to achieve the purpose of reducing body weight and controlling basal metabolic rate. Proper exercise helps to control 3 high and reduce weight, and its role should not be neglected as well. Note: The key to reducing the harmful effects of carotid stenosis is early consultation with a specialized vascular surgery department for early diagnosis and treatment to reduce the incidence and harm of stroke.