1.What are the main causes of carotid artery stenosis?
The main cause of carotid artery stenosis is atherosclerosis, which accounts for more than 90% of the cases. In addition, there are also rare causes such as aortitis, trauma and radiation injury.
2.What are the risk factors for the occurrence of carotid artery stenosis?
Carotid artery stenosis due to atherosclerosis is mostly seen in middle-aged and elderly people, and is often accompanied by a variety of cardiovascular risk factors.
Carotid artery stenosis caused by cephalothoracic aortitis is mostly seen in adolescents, especially in young women.
Carotid artery stenosis caused by injury or radiation has a history of corresponding injury or radiation exposure before the onset of the disease.
3.Classification of carotid artery stenosis
Carotid artery stenosis is clinically classified into two categories: symptomatic carotid stenosis and asymptomatic carotid stenosis, based on whether the stenosis produces symptoms of cerebral ischemia.
4.What are the main symptoms of carotid stenosis?
(1) Cerebral ischemic symptoms: tinnitus, vertigo, blackness, blurred vision, dizziness, headache, insomnia, memory loss, drowsiness, dreaminess, etc. Ocular ischemia is manifested as vision loss, hemianopia, diplopia, etc. Many patients with carotid stenosis do not have any clinical signs and symptoms of the nervous system. Sometimes, only a weakened or absent carotid pulsation is detected during physical examination, and a vascular murmur is heard at the root of the neck or at the carotid artery line.
(2) TIA is a transient loss of local neurological function, which is characterized by transient sensory or motor dysfunction of one limb, transient monocular blindness or aphasia, etc. It usually lasts only a few minutes and recovers completely within 24h after the onset. There is no focal lesion on imaging.
(3) 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.
Asymptomatic carotid artery stenosis, especially severe stenosis or plaque ulceration, is recognized as a “high-risk lesion” and is receiving more and more attention.
5.Which patients need to be screened for carotid stenosis?
Atherosclerosis is a systemic disease. Age (>60 years), gender (male), long-term smoking, obesity, hypertension, diabetes, hyperlipidemia and other risk factors for cardiovascular disease are also applicable to screening for carotid artery stenosis due to atherosclerosis.
High-risk groups include patients with TIA and ischemic stroke, patients with lower extremity atherosclerotic occlusive disease, patients with coronary artery disease (especially those requiring coronary artery bypass or intervention) and those with carotid artery vascular murmurs detected during physical examination.
6.Diagnosis of carotid artery stenosis can be diagnosed by clinical manifestations and non-invasive auxiliary examinations, but DSA is still an indispensable basis for confirming the diagnosis and formulating the plan.
7.What are the auxiliary tests for carotid artery stenosis?
(1) Doppler-ultrasound examination.
(2) Magnetic resonance angiography
(3) CT angiography
(4) Digital subtraction angiography (DSA) is still the “gold standard” for the diagnosis of carotid stenosis.
8.Grading of carotid artery stenosis.
The degree of internal carotid artery stenosis is divided into 4 grades.
(1) Mild stenosis, where the internal diameter of the artery is reduced by <30%.
(2) Moderate stenosis, with a 30% to 69% reduction in the internal diameter of the artery.
(3) Severe stenosis, with 70% to 99% reduction in the internal diameter of the artery.
(4) Complete occlusion.
9.What are the treatment objectives and methods for carotid stenosis?
The purpose of treatment for carotid stenosis is to improve cerebral blood supply, correct or relieve the symptoms of cerebral ischemia, and prevent the occurrence of TIA and ischemic stroke. Treatment is based on the degree of carotid stenosis and the patient’s symptoms, including medical treatment, surgical treatment and interventional treatment.
10. Indications and methods of medical treatment for carotid stenosis
Conservative medical treatment aims to reduce the symptoms of cerebral ischemia, reduce the risk of stroke, and control existing diseases such as hypertension, diabetes, hyperlipidemia and coronary heart disease. Internal conservative treatment includes the following.
(1) Reducing body weight.
(2) Smoking cessation.
(3) Limiting alcohol consumption.
(4) Anti-platelet aggregation therapy: Many large randomized, prospective multicenter clinical trials have confirmed that anti-platelet aggregation drugs can significantly reduce the incidence of cerebral ischemic disease, clinically used drugs such as aspirin, ticlopidine (ticlopidine, the trade name against kleider).
(5) Improve the symptoms of cerebral ischemia.
(6) Regular ultrasound examination, dynamic monitoring of changes in the condition.
11.The purpose of surgical treatment of carotid artery stenosis
The aim of surgical treatment of carotid stenosis is to prevent the occurrence of stroke, followed by the prevention and slowing down of TIA. The standard surgical procedures are carotid endarterectomy (CEA) and carotid artery stenting (CAS).
12. Indications for CEA and CAS surgery
(1) Carotid artery stenosis (70% to 99%) with symptoms ipsilateral to the stenosis, indications.
(2) Carotid artery stenosis (30% to 69%) with symptoms of cerebral ischemia ipsilateral to the stenosis, indications.
(3) For carotid artery stenosis (0% to 29%) with symptoms ipsilateral to the stenosis, treatment is not beneficial.
(4) For asymptomatic carotid artery stenosis (60% to 99%), it is beneficial.
13.What are the main complications of CEA?
Complications of CE include perioperative stroke and death; as well as cerebral nerve injury, wound hematoma infection, postoperative hypertension, and postoperative hyperperfusion syndrome; the incidence of myocardial infarction and hypotension is low.
14.What are the main complications of CAS?
Complications of carotid artery stenting.
(1) Postoperative restenosis rate <5%.
(2) Low incidence of stent deformation, collapse, and displacement.
(3) Other complications such as vasospasm, stroke, hematoma formation, etc. are similar to those of PTA.
15.Dietary guidance for carotid artery stenosis
(1) Dietary prescriptions for carotid stenosis.
Eat a balanced diet, more fruits and vegetables and other high-fiber foods, more eggs, soybeans and other high-protein foods, pay attention to a light diet, and moderate exercise can be performed
(2) What foods are best not to eat for carotid artery stenosis?
Avoid smoking, alcohol, spicy, coffee and other stimulating foods
16.Preventive health measures for carotid artery stenosis
(1) Because the main causes of this disease are atherosclerosis, aortitis, trauma and radiation injury, active treatment and prevention of the primary disease is the key to prevent this disease.
(2) Carotid percutaneous transluminal angioplasty or carotid stenting implantation can be performed to eliminate potential sources of emboli and prevent the occurrence of stroke if significant carotid stenosis is detected.