What is cerebral artery stenosis? The cerebral arteries are the arteries that supply blood to our brain, including both intracranial and extracranial arteries that supply intracranial blood flow. Narrowing of the cerebral arteries is caused by a variety of factors. The most common cause is atherosclerosis, which causes thickening of the intima, plaque formation, and narrowing of the lumen of the cerebral arteries. What are the consequences of cerebral artery stenosis? Stenosis of the cerebral arteries is one of the risk factors for stroke. Narrowing of the lumen of the cerebral artery to a certain extent can affect the supply of cerebral blood flow distal to the narrowing, causing ischemia and hypoxia in the brain tissue, resulting in a series of symptoms. If the plaque causing the stenosis is unstable and part of the plaque comes off, it can follow the blood flow to the distal vessels and block them. A ruptured plaque can also form a local thrombus and block a blood vessel, causing a stroke. How does cerebral artery stenosis develop? Ninety percent of them are caused by atherosclerosis. Long-term hypertension, hyperlipidemia, poorly controlled diabetes, and long-term smoking are all causes of cerebral artery stenosis. In addition, arteritis, hyperhomocysteine, smog, trauma, etc. are other causes. What are the symptoms of cerebral artery stenosis? Some patients may not have any symptoms, but only have cerebral artery stenosis detected during a physical examination with a cerebrovascular ultrasound. Most patients show non-specific symptoms, such as headache, dizziness, dizziness, vertigo, tinnitus, numbness, weakness, memory loss, blurred vision, weakness, etc. Some patients also present with transient cerebral ischemic attack or cerebral infarction. How to detect cerebral artery stenosis? The method of cerebrovascular auscultation is often used clinically. Hearing a murmur indicates a stenosis, but if the stenosis is very severe, the murmur will become smaller or even disappear. The murmur also disappears when the vessel is occluded. In addition, hearing a murmur does not necessarily mean cerebral artery stenosis, and further tests are needed to determine this. In addition, reduced pulsation of one carotid or radial artery and significantly different blood pressure bilaterally suggest possible stenosis or occlusion of the carotid or subclavian arteries. What tests can detect cerebral artery stenosis? Ultrasound is the best method to screen for cerebral artery stenosis and is divided into two types of ultrasound: intracranial and extracranial. Transcranial multispectral ultrasound (TCD), also known as “cerebral hemogram”, is used to examine the intracranial cerebral arteries for stenosis or occlusion because of its low frequency and ability to penetrate the skull. Color duplex ultrasound (TCCD), also known as “color ultrasound”, is used to examine the arteries in the neck for stenosis, which are part of the cerebral arteries that supply blood to our brain. Ultrasound is very visual and allows you to see whether there is thickening of the intima of the carotid artery wall, whether there is plaque, whether there are ulcers on the surface of the plaque and the degree of stenosis. The advantages of ultrasound are that it is not damaging to the body and is inexpensive. It can also be used to monitor the effect of treatment after the stenosis is detected and can be reviewed periodically after treatment. Patients who need to be screened include those who can hear a vascular murmur on examination; those who have had a TIA and cerebral infarction; those who have risk factors for atherosclerosis; and normal people older than 50 years of age who are being examined. Patients screened by ultrasound can undergo further examinations, such as: MRI angiography, CT angiography, and digital subtraction angiography. MRI angiography (MRA) is also a non-invasive test that clearly and visually shows the cerebral vessels and is more accurate than TCD for localization, but is more expensive. CT angiography (CTA) requires contrast injection. Digital subtraction angiography (DSA) is the most accurate of all vascular examinations and is known as the “gold standard” of vascular examination. However, it requires insertion of a tube into the vessel, injection of contrast, special equipment and staff, and is more expensive. What should I do if I already have a narrowed cerebral artery? When a narrowing of the cerebral arteries is detected, the cause of the narrowing, or “risk factors,” needs to be further examined. This is done in order to provide targeted treatment to prevent cerebral infarction. Risk factors include blood pressure, lipids, blood glucose, fibrinogen, homocysteine, etc. If they are not caused by atherosclerosis, other tests such as inflammation and immunological indicators are also performed. How is cerebral artery stenosis treated? The treatment includes medication, interventional therapy and surgery. The first step is to change the poor lifestyle, quit smoking, limit alcohol, low salt and low fat, and have a balanced diet. Treatment should also be tailored to the risk factors present in each patient, including lipid regulation, plaque stabilization, blood pressure control, reduction of high fibrinogen, and control of hyperhomocysteine. In addition, antiplatelet aggregation drugs, such as aspirin or clopidogrel, should be used to prevent stroke. Interventional or surgical treatment should be considered if the cerebral artery stenosis is severe and there are accompanying symptoms. Interventional treatment is the placement of a stent at the site of the stenosis. Surgical treatment includes carotid endarterectomy and various bypass procedures. All treatments are aimed at preventing strokes.