Carotid Atherosclerosis Stenosis: The Real Killer Behind the Scenes of Stroke With the aggravation of the global population aging process, cardiovascular and cerebrovascular diseases have become the number one killer threatening human health. In China, stroke is the leading cause of death and disability. However, its real culprit – “carotid atherosclerotic stenosis” is little known, about 30% – 40% of the stroke is caused by carotid atherosclerotic stenosis. However, “stroke can be prevented”, carotid endarterectomy (CEA for short) has been used in the treatment of extracranial carotid atherosclerotic stenosis and the prevention of stroke for more than 50 years, and is internationally recognized as the “gold standard” for stroke prevention. The carotid arteries control the blood supply to the brain. The carotid artery controls the blood supply to the brain The carotid artery is responsible for 2/3 of the brain’s blood supply, and is an irreplaceable energy supply pipeline for the human body’s Commander-in-Chief. Carotid atherosclerotic stenosis is a condition in which the atherosclerotic plaques caused by various reasons narrow or occlude the lumen of the carotid arteries. The disease is relatively unknown to most people, while stroke is widely known and talked about. What is the mysterious relationship between carotid atherosclerotic stenosis and stroke? According to the latest epidemiologic statistics, stroke is the third leading cause of death among U.S. residents, with about 140,000 to 150,000 people dying of stroke each year, of which 30% to 40% are caused by atherosclerotic stenosis of the carotid arteries. Statistics further show that about 80% of stroke patients have no symptoms before the onset of the disease, and even have no history of small stroke attacks. Statistics from the World Health Organization (WHO) show that one in every six people in the world is likely to suffer from stroke, one person dies of stroke every six seconds, and one person is permanently disabled by stroke every six seconds. Once a stroke occurs, it will bring a heavy burden to individuals, families and even society. In our country, stroke has become the first cause of death among the residents and is the number one killer threatening people’s lives and health. More seriously, China has nearly 100 million diabetics, about 220 million hypertensive patients, about 200 million dyslipidemia, about 240 million overweight and obese people, smokers about 350 million. These are all risk factors for the formation of atherosclerotic plaques in the carotid artery wall, promoting the formation of atherosclerotic stenosis in the carotid artery. When these plaques increase in size or rupture, ruptured plaque emboli will be formed, and these emboli enter the skull under the impact of blood flow, causing intracranial vascular embolism and thus causing stroke. In addition, ischemic stroke occurs when the lumen of the carotid artery is further narrowed to the point of occlusion. Therefore, carotid atherosclerotic stenosis is the real killer behind the scenes of stroke. Stroke prevention requires attention to the cause of treatment Although stroke is scary, we are not helpless against it. More than 50 years of experience in Europe and the United States has confirmed that carotid endarterectomy can prevent the occurrence of stroke. Carotid endarterectomy has been widely accepted by patients and doctors in Europe and the United States, and has become the “gold standard” for stroke prevention. In China, due to many reasons, carotid endarterectomy is not only not accepted, but also not even heard of by many people and medical personnel, let alone widely promoted. In response, on June 21, 2009, the Ministry of Health officially launched the “Stroke Screening and Prevention Project”. As a major national health intervention project in China, the project draws on the successful experience of advanced countries in Europe and the United States and puts forward the concept of “ultrasound screening of carotid plaques” as a breakthrough, carotid endarterectomy and other advanced technologies as a guarantee, rational use of medication, standardized treatment and prevention program. The prevention and treatment program of “carotid endarterectomy” is proposed. However, in view of the current national conditions in China, it is urgent that some medical workers and most of the people still lack a full understanding of carotid atherosclerotic stenosis and its harm, and they do not know that carotid atherosclerotic stenosis is the real cause of cerebral stroke, and the phenomenon of “treating the head when there is a headache, and treating the feet when there is a foot injury” is still prevalent, and the treatment can not be done from the cause of the disease. The treatment can not be done from the cause of the disease. So increase the popularization of knowledge of the disease, early diagnosis, early treatment, stroke can be prevented, “on the doctor to cure the disease” is not a dream. Removal of carotid plaque can effectively prevent stroke Carotid endarterectomy for extracranial segment carotid atherosclerotic stenosis of the treatment of the disease began in the 1950’s, there have been a large sample of clinical studies have made it clear that the operation of the significant preventive effect of stroke: it can reduce the risk of stroke of about 1/3 of the patients, and the total risk of stroke (including the occurrence of intraoperative stroke) is 13.4% among the patients who have had the operation at an early stage of the treatment. The overall 10-year risk of stroke (including intraoperative stroke) increased from 13.4% in patients treated with early surgery to 17.9% in patients treated with late surgery or no surgery. Moreover, in patients with symptomatic carotid atherosclerotic stenosis, the incidence of mini-strokes and post-infarction sequelae was significantly lower in the carotid endarterectomy patients than in the drug-treated group. How can carotid plaque be removed? Carotid endarterectomy is simply to cut the carotid artery to remove the carotid artery atherosclerosis and stenosis plaque and then suture it back together, in order to minimize the occurrence of postoperative restenosis can be used in the carotid artery to make a patch “patch”, or the use of the method of externalization to make the anastomosis widened. Among them, the external flap carotid endarterectomy is very suitable for promoting in China because of its short carotid artery blockage time, no need for patches to reduce costs, simultaneous anastomosis shaping, and correction of twisted internal carotid arteries. In the Department of Vascular Surgery of Shanghai Changzheng Hospital, more than 90% of carotid endarterectomies are performed with this procedure. The average operation time is about 50 minutes and the average carotid artery blocking time is about 15 minutes, and the surgical techniques and methods used are up to the international advanced level. New technology allows more patients to benefit from the According to the 2011 U.S. guidelines for the diagnosis and treatment of extracranial segmental carotid and vertebral artery disease, the indications for surgery for carotid atherosclerotic stenosis can be summarized as follows: symptomatic carotid atherosclerotic stenosis, with a stenosis of more than 50% of the lumen, and asymptomatic patients, with a stenosis of more than 70% of the lumen, are all indications for surgery. Traditionally, there are also some contraindications to surgery, such as advanced age, carotid occlusion, post-radiotherapy carotid artery, acute carotid occlusion, and so on. From the experience, for patients with almost occluded or occluded internal carotid arteries and a history of stroke, carotid endarterectomy can not only remove plaque, restore the lumen and prevent stroke, but also improve the patients’ cognitive functions such as limb mobility disorders, language, and memory to different degrees. For patients with acute internal carotid artery embolism and ipsilateral stroke, early carotid endarterectomy can reduce or alleviate neurological complications, and has a positive effect on the patient’s prognosis. We have accumulated dozens of successful cases of surgery. These patients with acute internal carotid artery embolism leading to ischemic stroke and hemiplegia recovered their ability to walk after surgery. Thus, patients with carotid atherosclerotic stenosis and high-risk factors can undergo carotid endarterectomy with good outcomes under strict preoperative evaluation, including cardiac ultrasound and pulmonary function monitoring, as well as close intraoperative monitoring and perioperative management. In recent years, with the development of many new carotid artery surgical techniques, Qu Lefeng’s vascular surgery team can shorten the operation time by 1/2 to 2/3, and reduce the complication rate from 3-6% to less than 1%; break the traditional time window to carry out emergency carotid endarterectomy; and explore the surgical treatment of carotid artery occlusion, carotid stenting post-stenting stenosis / occlusion, carotid atherosclerotic stenosis after radiotherapy, and huge carotid aneurysm near the skull base. Surgical treatment of carotid artery occlusion. At the same time, the new transverse neck incision, the first of its kind in China, significantly reduces postoperative incision pain, numbness and scarring. It contributes significantly to the aesthetic appearance of the patient’s neck after surgery and improves their quality of life and self-confidence. Therefore, traditional risk factors for carotid endarterectomy must be reassessed so that more patients can benefit from it. Carotid endarterectomy, the “gold standard” for treating atherosclerotic stenosis of the carotid arteries and preventing stroke, is like gold drowned in dust and sand in China, failing to play its proper role. Due to the high technical requirements of the procedure, the difficulty of the operation and the dangerous complications, only a few hospitals and doctors have been able to carry out this operation in the past 20 years, and there has been no breakthrough. What is even more terrible is that the concept of carotid atherosclerosis stenosis and the harm is not known to most people, in the context of the Ministry of Health’s “Stroke Screening, Prevention and Control Project”, we can only vigorously popularize the knowledge and promote the technology, in order to prevent and treat strokes in a truly practical manner.