(1) Q: My father suddenly developed hemiplegia six months ago and went to the neurology department, the doctor said it was a cerebral infarction. Zhang Wangde, Department of Vascular Surgery, Beijing Chaoyang Hospital A: Stroke is a term used by the common people, who usually refer to a series of manifestations in the brain caused by ischemia or hemorrhage in a general way as stroke. Stroke and cerebral stroke are general terms for cerebrovascular accidents, which include hemorrhagic cerebrovascular disease and vaso-occlusive cerebrovascular disease, both of which can cause cerebral infarction (brain tissue necrosis). Cerebral thrombosis is mostly due to the hardening and narrowing of the cerebral arteries themselves, and local clotting causes cerebral artery blockage when the blood is hypercoagulated. Cerebral embolism, on the other hand, is caused by the blockage of cerebral arteries by gas, liquid or solid floating materials in the blood outside the brain. (2) Q: When my father was hospitalized, the ultrasound examination said that the carotid artery stenosis was very serious, and the doctor said that his cerebral infarction was greatly related to the carotid artery stenosis. A: There are two very important blood vessels in the neck called carotid arteries, which provide more than 80% of the blood supply to the brain tissue. Carotid artery stenosis can cause cerebral blood supply to be reduced, in addition to cerebrovascular disease because the atherosclerotic plaque in the stenosis can be broken, local thrombosis can be dislodged, and bleeding can occur within the plaque. (3) What are the symptoms of stroke caused by carotid stenosis? A: Patients with severe carotid stenosis can show symptoms of cerebral ischemia such as dizziness, blurred vision and memory loss. There are also many patients who have no obvious symptoms, but are mostly over 50 years old and often have hypertension, diabetes, and atherosclerosis (such as coronary artery disease and limb ischemia). The most typical symptoms of carotid stenosis are: sudden onset of dizziness, temporary darkness in one eye, numbness and weakness in one arm and leg, and slurred speech. These symptoms can occur in minutes or hours, but disappear completely within 24 hours, which is often referred to as a “mini-stroke” or “cerebral vasospasm”. Patients may also experience prolonged or permanent neurological damage – a stroke, where the patient experiences prolonged or permanent hemiparesis, inability to speak, etc., which can lead to death in severe cases. 4) I now understand the relationship between carotid stenosis and stroke, but how can I solve this carotid stenosis? A: One way is to perform carotid endarterectomy, which removes the hardened and hyperplastic endothelium from the carotid artery stenosis to avoid embolism or thrombosis there. The procedure is not too big, the effect is really good, the safety is better, and it is suitable for universal implementation. In recent years an advanced technique using modern high-tech achievements, endoluminal carotid stenting, has been developed. It does not open an incision, but only sticks a needle at the root of the thigh and introduces a stent from the blood vessel to prop up the stenosis of the carotid artery, lifting the local stenosis and isolating the atherosclerotic plaque. It is a quick recovery with little damage. 5) My father’s carotid artery is 80% narrowed in diameter, but his hemiplegia is much better, he was unable to walk, but now he can walk slowly on the ground. A: It is not necessary to operate or put a stent in the carotid artery when there is a problem. There is no point in repairing carotid artery stenosis when the carotid artery is completely occluded or when there is a serious irreversible stroke. The following cases require repair of carotid stenosis: first, people with frequent small strokes (TIA), except for other factors should be actively prevented; second, carotid stenosis is relatively heavy, the best prevention effect of surgery when the stenosis reaches 70-99%. Third, surgery or stenting may also be considered for stroke prevention in some male patients with 50-69% symptomatic stenosis and in male patients with more than 60% asymptomatic stenosis. Patients who have had a stroke but have recovered well have carotid stenosis. Within 3-4 years after the first episode, 20-45% will develop a complete stroke. This should be treated aggressively with repair. The examination reveals uneven surface and texture of carotid artery sclerosis plaque, or ulceration or bleeding inside the plaque should be highly alert. Carotid endarterectomy or carotid artery stenting should be performed according to your father’s specific situation. If left untreated, the likelihood of your father having a recurrent cerebral infarction is much greater than average, and the symptoms of recurrence may be more severe than the first. 6) But is there a risk of having surgery or stenting for carotid artery stenosis? What are the risks? A: Generally speaking, the risks are not great, mainly: transient neurological symptoms, most of which can be recovered quickly, with rare cases of hemiparesis and aphasia, and very few deaths (neurological or cardiogenic). incidence is under 1%. 7) I understand, I mobilize my father to have carotid artery surgery, can you introduce which hospital in Beijing has the advantage to do such surgery? A: The Department of Vascular Surgery of Beijing Chaoyang Hospital has rich experience and high technology in the surgical treatment of various peripheral vascular diseases, in addition, the interventional treatment of various peripheral vascular diseases is also unique.