I. What are the main causes of carotid stenosis?
The main cause of carotid artery stenosis is atherosclerosis, which accounts for more than 90% of the cases. In addition, there are also rare causes such as aortitis, trauma and radiation injury.
What are the risk factors for carotid artery stenosis?
Carotid artery stenosis due to atherosclerosis is mostly seen in middle-aged and elderly people, and is often accompanied by a variety of cardiovascular risk factors.
Carotid artery stenosis caused by cephalothoracic aortitis is more common in adolescents, especially in young women.
Carotid artery stenosis caused by injury or radiation has a history of corresponding injury or radiation exposure before the onset of the disease.
Classification of carotid artery stenosis
Carotid artery stenosis is clinically classified into two categories: symptomatic and asymptomatic, depending on whether it produces cerebral ischemic symptoms.
1.Symptomatic carotid stenosis
2.Asymptomatic carotid stenosis
IV. What are the main symptoms of carotid stenosis?
1, cerebral ischemic symptoms: tinnitus, vertigo, blackness, blurred vision, dizziness, headache, insomnia, memory loss, drowsiness, and dreaminess may be present. Ocular ischemia is manifested as vision loss, hemianopia, diplopia, etc. Many patients with carotid stenosis do not have any clinical signs and symptoms of the nervous system. Sometimes only weakened or absent carotid artery pulsations are found during physical examination, and vascular murmurs are heard at the root of the neck or at the carotid artery line.
2, TIA localized transient loss of neurological function, clinical manifestations of one limb sensory or motor dysfunction, transient monocular blindness or aphasia, etc., usually only a few minutes, the onset of 24h after the complete recovery. There is no focal lesion on imaging.
3. Ischemic stroke: Common clinical symptoms include sensory impairment of one limb, hemiparesis, aphasia, cerebral nerve damage, and in severe cases, coma, with corresponding neurological signs and imaging features.
Asymptomatic carotid stenosis, especially severe stenosis or plaque ulceration, is recognized as a “high-risk lesion” and is receiving increasing attention.
Which patients need to be screened for carotid stenosis?
Carotid artery stenosis risk factors and high-risk groups Atherosclerosis is a systemic disease, and various risk factors for cardiovascular disease such as age (>60 years), gender (male), long-term smoking, obesity, hypertension, diabetes and hyperlipidemia are also applicable to screening for carotid artery stenosis due to atherosclerosis.
High-risk groups include patients with TIA and ischemic stroke, patients with lower extremity atherosclerotic occlusive disease, patients with coronary artery disease (especially those requiring coronary artery bypass or intervention) and those with carotid artery vascular murmurs detected during physical examination.
Diagnostic basis for patients with carotid artery stenosis
Diagnostic basis Carotid artery stenosis can be diagnosed through clinical manifestations and noninvasive ancillary tests, but DSA is still an indispensable basis for confirming the diagnosis and formulating a plan.
VII. What are the auxiliary tests for carotid stenosis?
1.Doppler-ultrasound examination.
2.Magnetic resonance angiography
3.CT angiography
4.Digital subtraction angiography Digital subtraction angiography is still the “gold standard” for the diagnosis of carotid artery stenosis.
VIII. Classification of carotid stenosis
The degree of internal carotid artery stenosis is divided into 4 grades.
1.Mild stenosis, where the internal diameter of the artery is reduced by <30%.
2.Moderate stenosis, with the internal diameter of the artery reduced by 30% to 69%.
3.Severe stenosis, with 70% to 99% reduction in the internal diameter of the artery.
4.Complete occlusion.
What are the treatment objectives and methods for carotid artery stenosis?
The purpose of treatment for carotid stenosis is to improve cerebral blood supply, correct or relieve the symptoms of cerebral ischemia; prevent TIA and ischemic stroke. Treatment is based on the degree of carotid stenosis and the patient’s symptoms, including medical treatment, surgical treatment and interventional treatment.
X. Indications and methods of medical treatment for carotid stenosis
Internal conservative treatment aims to reduce the symptoms of cerebral ischemia, reduce the risk of stroke, and control the existing diseases such as hypertension, diabetes, hyperlipidemia and coronary heart disease. Internal conservative treatment includes the following.
1. reducing body weight.
2. smoking cessation.
3, limiting alcohol consumption.
4, anti-platelet aggregation therapy: many randomized, prospective multicenter large clinical trials have confirmed that anti-platelet aggregation drugs can significantly reduce the incidence of cerebral ischemic disease, the commonly used drugs in clinical practice are aspirin, ticlopidine (ticlopidine, trade name against kleider), etc..
5, to improve the symptoms of cerebral ischemia.
6, regular ultrasound examination, dynamic monitoring of changes in the condition.
The purpose of surgical treatment of carotid artery stenosis
The purpose of surgical treatment of carotid stenosis is to prevent the occurrence of stroke, and secondly, to prevent and slow down the onset of TIA. The standard surgical procedures are carotid endarterectomy (CEA) and stenting of carotid stenosis (CAS)
XII. Indications for CEA and CAS surgery.
1, carotid stenosis (70% to 99%) with symptoms ipsilateral to the stenosis, indications.
2, carotid stenosis (30% to 69%) with symptoms of cerebral ischemia ipsilateral to the stenosis, indications.
3. for carotid artery stenosis (0% to 29%) with symptoms ipsilateral to the stenosis, treatment is not beneficial
4.For asymptomatic carotid stenosis (60% to 99%), it is beneficial.
XIII. What are the main complications of CEA?
Complications of CE include perioperative stroke and death; and cerebral nerve injury, wound hematoma infection, postoperative hypertension, and postoperative hyperperfusion syndrome; the incidence of myocardial infarction and hypotension is low.
XIV. What are the main complications of CAS?
Complications of carotid artery stenting: ① postoperative restenosis rate <5%; ② low incidence of stent deformation, collapse and displacement; ③ other complications such as vasospasm, stroke, hematoma formation, etc. are similar to PTA.
XV. Dietary guidance for carotid artery stenosis
1. Dietary prescriptions for carotid stenosis.
A balanced diet, more fruits and vegetables and other high-fiber foods, more eggs, soybeans and other high-protein foods, attention to a light diet, and moderate exercise.
2, carotid stenosis best not to eat what food?
Avoid smoking, alcohol, spicy, coffee and other stimulating foods
Sixteen, carotid artery stenosis preventive health measures
1, because the most important cause of this disease is atherosclerosis, aortitis, trauma and radiation injury, so active treatment and prevention of the original disease is the key to prevent this disease.
2, found to have obvious carotid stenosis can do carotid percutaneous transluminal angioplasty or carotid stenting implantation to eliminate the potential source of emboli and prevent the occurrence of stroke.