Typical symptoms: sudden darkening of the eye 57-year-old Chen, in addition to a little high blood pressure, nothing serious health problems. But in recent months he often had a sudden blackening of the left eye, and it did not last long, and he was fine after a while, so he did not pay much attention to it. When this situation appeared more and more often (sometimes more than a dozen episodes a day), he went to the hospital to see the ophthalmologist. The ophthalmologist checked for half a day and said there was nothing wrong with his eye. But he felt that the blackness in his left eye was getting worse. After moving around several hospitals and departments, he had a color ultrasound examination of the carotid artery in the vascular surgery department, which finally revealed plaque formation and severe luminal stenosis in the beginning segment of the left internal carotid artery. This eye symptom of Lao Chen is a transient blackness, which is one of the typical symptoms of carotid artery stenosis. This symptom mostly occurs in one side of the eye, and the attack does not last long, and can be relieved by itself after ten seconds to a few minutes. Other symptoms: The majority of patients with carotid stenosis of large and small strokes are more commonly seen as manifestations of insufficient blood supply to the brain, such as drowsiness and memory loss throughout the day. If timely intervention is made, this hypofunction caused by simple ischemia and hypoxia can gradually recover after improving blood flow. A small percentage of patients develop a mini-stroke. Other symptoms caused by carotid stenosis are very similar to those of a stroke: weakness of one limb, unstable holding, oblique walking, sudden slurred speech, crooked mouth, sudden syncope, and even urinary and fecal disturbances. However, these symptoms usually recover within 24 hours, so they are also called mini-strokes. This is called a transient ischemic attack (TIA), in which a plaque in the carotid artery stenosis is dislodged by the impact of blood flow and then enters the intracranial arteries with the blood flow, causing a transient spasm of the artery or an embolism of the terminal branch of the artery, resulting in transient ischemia in the corresponding area. When these small fragments enter the ophthalmic artery of the intracranial artery, symptoms like those of Lao Chen can occur. Major Stroke If the detached intimal plaque is not small enough to be ablated by the blood or is stuck in an artery, it can lead to blockage of the stuck artery and cause a stroke with symptoms such as hemiplegia, hemianopia, hemianesthesia, inability to care for oneself, and uncontrollable bowel and urine. Don’t forget to see cardiovascular surgery Most patients with TIA symptoms first think of going to neurology or ophthalmology. However, if it is a transient ischemia that has not yet caused qualitative changes in the target organ from quantitative changes, routine examinations (such as CT, MRI or fundus examination) will not show positive findings, or only cataracts, cervical spondylosis, cerebral infarction foci, etc. will be found. If one is satisfied with these findings, the hidden problem of carotid artery stenosis will be ignored. In fact, a simple method for definitive diagnosis of carotid stenosis is color Doppler examination. This method is also inexpensive, effective, noninvasive, and has a sensitivity and specificity of more than 90%. The key is for both the doctor and patient to be aware of the carotid artery examination when they encounter a suspicious condition. People who have had a stroke especially need to be aware of the need for reexamination. Carotid angiography (DSA) provides more precise details about the site, length, and extent of carotid stenosis, and soft and hard plaques. However, it is an invasive test and may cause hematoma at the puncture site, arteriovenous fistula formation, etc. It also requires bed rest for 24 hours after the imaging. In recent years, the application of non-invasive CTA as well as MRA techniques can also give comprehensive information about arterial stenosis with less radiation damage than DSA. Surgical and interventional treatment should be actively performed in all cases of arterial stenosis of 50% to 70% with symptoms and in cases of stenosis >70%. Conventional surgery (i.e. carotid endarterectomy CEA) CEA is the standard treatment for carotid stenosis and has been performed for more than 50 years. According to the postoperative follow-up observation in our vascular surgery center, the application of carotid patching has reduced the chance of carotid artery restenosis. Interventional therapy (CAS) This means that a vascular stent is placed in the stenotic segment of the carotid artery through an arterial puncture technique to dilate the carotid artery, thereby ensuring a smooth flow of blood through the carotid artery. The advantages are minimally invasive, rapid recovery, and a much shorter hospital stay. The indications are: elderly patients with severe cardiovascular disease, severe stenosis with difficult surgical access (high stenosis), restenosis after radiotherapy, restenosis after CEA, and entrapment stenosis, etc. However, the cost of interventional treatment is currently higher than that of traditional surgery. The old Chen mentioned at the beginning of the article, after being treated with carotid endarterectomy, the black symptom of his left eye completely disappeared. According to statistics, most of the patients with carotid stenosis treated in our department complained of symptom relief: their minds became clearer, their hands and feet became lighter, and their original TIA symptoms were also improved. It can be seen that the effect of surgical intervention is still very significant.