The American Journal of Stroke reports that risk factors for stroke can include family history, smoking, atrial fibrillation, hypertension, diabetes, dyslipidemia, carotid artery stenosis, and physical inactivity. If you have one or more of these factors, you may be at high risk for stroke. For people who are at high risk of stroke, there are three lines of prevention: first, lifestyle intervention. To prevent hypertension, hyperlipidemia, hyperglycemia and atherosclerosis by adjusting the diet and changing the lifestyle; for middle-aged and elderly people with high-risk factors, regular hospital check-ups and carotid artery screening are recommended. Secondly, if symptoms such as transient dizziness, headache, crooked mouth and numbness of limbs occur, you should go to the hospital as soon as possible and seek active treatment to avoid cerebral infarction. Third, once you have a transient blackout or have had a stroke attack, you should be hospitalized as soon as possible for systematic examination and treatment to change passive treatment to active prevention and to prevent the problem before it happens. Many patients have a unique “warning signal”, called “transient cerebral ischemia” in medical terminology, before a stroke occurs. During this phase, patients experience dizziness, headache, and blurred vision, but they return to normal soon afterwards, no different from normal people. Therefore, many patients with “transient cerebral ischemia” take it lightly and think they are not sick; however, as the disease progresses, most of these patients will have a stroke three to five years later, causing irreparable neurological dysfunction (hemiplegia, aphasia, etc.) and even death. The onset of transient ischemia and stroke may appear to be in the brain, but the root of the trouble is actually in the neck. According to the New England Journal of Medicine, the world’s top professional journal, about 68% of people with a history of “transient cerebral ischemia” have carotid plaque; and about 60% of people with carotid atheroma have cerebral ischemia or stroke. It turns out that the carotid arteries, located on both sides of the neck, are the main source of blood supply to the brain. When atherosclerosis occurs in the carotid arteries, many small plaques are formed causing the lumen of the vessels to become smaller and prone to symptoms of cerebral ischemia. If these plaques are dislodged, they form a floating thrombus, which “drifts” from the large blood vessels to the small blood vessels until they are completely blocked, causing ischemic stroke. Therefore, carotid artery plaque can be considered a “time bomb” for stroke; carotid artery screening should be performed for people at high risk of stroke, especially those with transient cerebral ischemia. What are the clinical screening tools for carotid artery screening? Carotid bifunctional ultrasound is often used to determine the site and degree of carotid stenosis. Other screening methods include CT angiography (CTA), magnetic resonance angiography (MRA), and cerebral digital subtraction angiography (DSA). Ultrasound is the preferred test and digital subtraction angiography is the “gold standard”. The proper use of these tests can provide an accurate and scientific basis for the detection and timely treatment of pre-stroke lesions. We recommend that first-time patients should choose carotid dual-function ultrasound, or “color ultrasound” as it is often called. “Color ultrasound is fast, inexpensive and non-invasive, and its specificity and sensitivity for carotid arteries with stenosis greater than 60% are above 90%. If you are an experienced ultrasonographer, “color ultrasound” can also provide more valuable information, such as whether the carotid plaque is soft or hard, whether there are ulcers on the surface of the plaque, and the stability of the plaque. This information is extremely valuable for the next treatment of patients. As for CTA and MRA examinations, besides understanding the lesions of the carotid artery, they can also provide imaging information of the aorta and intracranial vessels, which can help doctors understand the condition more comprehensively. Treatment after screening should be targeted Generally speaking, the higher the degree of carotid stenosis, the higher the incidence of stroke. Patients with severe carotid stenosis have a five-year stroke rate of more than 16%; if the patient is symptomatic, the stroke rate is even higher. The internationally recognized NASCET study (North American Symptomatic Carotid Endarterectomy Study) confirmed that patients with symptomatic carotid stenosis greater than 70% had a cumulative risk of ipsilateral stroke of 26% and an estimated fatal ipsilateral stroke of 13.1%, even with pharmacologic treatment. The incidence would be significantly reduced to 9% and 2.5%, respectively, if surgical treatment was performed. Treatment options for patients vary with respect to carotid screening results. Patients with less than 30% to 50% stenosis can receive regular medication and close follow-up; patients with greater than 70% stenosis require surgical intervention; for symptomatic patients with greater than 50% to 70% stenosis, surgical treatment can still significantly reduce the incidence of future strokes. So how do you unblock a narrowed carotid artery? The principle of treatment is “early”, which means early diagnosis and early treatment. There are two methods of treatment in our vascular surgery, one is “dilation”, that is, carotid artery stenting, and the other is “clearing”, that is, carotid artery endothelial debridement. The ischemic brain is like a tree on the verge of withering, timely watering can make it get new life, and once it withers, more efforts will not help.