Domestic patients mostly prefer stenting options, but carotid endarterectomy is the “gold standard”. 56-year-old calligrapher Mr. Yang used to wield his brush in front of the desk every morning, but this day he picked up his brush as usual and suddenly found that he couldn’t use his right side and it didn’t improve at all. The examination revealed that the main part of his left carotid artery had been narrowed by 65%, resulting in the formation of a cerebral infarction on the left side. The doctor said that the carotid stenosis had caused the symptoms of hemiplegia, and the next step should be to perform a carotid endarterectomy after a cerebral angiography. ”Why is it necessary to make an incision in the neck for a stroke? And to cut off the arterial intima?” This is the question of many patients with carotid artery stenosis. Recently, the reporter learned from the National Carotid Artery Stenosis Summit Forum hosted by the Guangzhou First People’s Hospital that the source of 60% to 70% of strokes is actually a “blockage” inside the carotid artery, and surgery is required when the stenosis reaches a certain level. The more effective and safer carotid endarterectomy, with lower costs and recurrence rates, is now the internationally recognized “gold standard”, while Chinese patients now prefer “stent” surgery, which has not been proven to be safe and effective. Stroke is not just a cerebrovascular problem. 60% to 70% of strokes are caused by carotid stenosis Stroke is currently the “number one killer” of Chinese people, with more than 2 million new cases each year. When a brain infarction or stroke occurs, patients and their families often think that they should only look for the cause in the brain, but ignore the root cause located in the neck. In the clinic for stroke patients to do imaging of the carotid artery, some patients will feel incomprehensible: “I have a stroke, why do I take pictures of my neck?” Professor Cao Zhikai, director of neurosurgery at Guangzhou First People’s Hospital, explained that stroke is caused by occlusion or bleeding of blood vessels in the brain after cerebral atherosclerosis, but in fact, 60% to 70% of it is due to narrowing of the carotid artery, because the normal carotid artery is responsible for supplying 85% of the blood to the brain tissue. In turn, carotid artery stenosis is mainly caused by the formation of atheromatous plaque in the bifurcation of the carotid artery. Hypertension and atherosclerosis can directly attack the carotid artery, especially the bifurcation of the common carotid artery and the beginning of the internal carotid artery, where the blood flows easily form vortices due to hemodynamics, and over time the vortices can damage the intima of the artery, and platelets and lipid components are deposited in the damaged area, slowly forming atherosclerotic plaques. When a person has high risk factors such as hypertension, hyperlipidemia, diabetes and obesity, carotid atherosclerotic plaque will easily appear. Poor lifestyles such as smoking, unhealthy diet and lack of exercise also tend to increase the risk of the disease. Carotid artery stenosis has few clinical symptoms, and many people are found to have neurological impairment during routine physical examinations. The most common is a “mini-stroke” (transient ischemic attack), in which patients often feel dizzy, dizzy, or faint suddenly; or blackness in front of the eyes, especially temporary blackness in one eye; numbness and weakness in one arm and leg; and slurred speech. This symptom may appear only for a few minutes or a few hours, but disappears completely within 24 hours. Once a stroke is caused, the nervous system is irreversibly damaged. Is stenting safer? Carotid endarterectomy is the “gold standard”. Conservative medical treatment for carotid stenosis is weight reduction, smoking and alcohol cessation, control of existing diseases (such as hypertension, diabetes, hyperlipidemia and coronary artery disease), and antiplatelet aggregation therapy to improve symptoms of cerebral ischemia and regular ultrasound examinations. However, asymptomatic carotid artery stenosis of more than 70% or stenosis of more than 50% with symptoms of stroke requires surgical treatment. The main surgical methods for treating carotid artery stenosis are carotid stenting and carotid endarterectomy. Professor Zhou Dingbiao, director of the Neurosurgery Branch of the Chinese Medical Association and chief physician of the Neurosurgery Department of Beijing 301 Hospital, introduced that the latter is a classical procedure that has been clinically proven in Europe and the United States for more than 50 years, and that carotid endarterectomy has been the “gold standard” for carotid stenosis treatment from the perspective of different versions of treatment guidelines around the world. The carotid endarterectomy has been the “gold standard” procedure for carotid stenosis for more than 50 years. However, carotid stenting has grown rapidly in China in recent years – 150,000 to 200,000 people in the United States undergo carotid endarterectomy each year, with only 10,000 to 20,000 stenting procedures. The opposite is true in China, where the ratio of stenting to carotid endarterectomy is 9:1. Is endarterectomy a vascular cut? In fact, from the current study, although stenting is minimally invasive, the complications are higher than carotid endarterectomy, and there is no difference between the two in postoperative recovery. Patients also need to take anticoagulant drugs after surgery. Experts say that the name “carotid endarterectomy” sounds a bit “scary”, but in fact, it is not the removal of its own tissue, the operation is done under a microscope, in simple terms, it is a small opening in the patient’s neck, cut open the narrowed carotid artery, peel off the formation of intravascular The surgery is done under a microscope. The patient is usually able to go to the floor the day after surgery.