What is carotid artery stenosis? The carotid artery is the main source of blood supply to the brain, and clinicians have found that the main cause of “stroke” is the narrowing and occlusion of the blood supplying arteries to the brain after long-term in-depth research. According to statistics, more than 60% of patients with cerebral ischemia are caused by carotid artery stenosis. How to treat carotid artery stenosis? When do I need treatment? There are three types of treatment for carotid stenosis: medication, open carotid surgery and carotid endovascular treatment (stentoplasty). 1. Drug treatment. The basic approach is to take long-term antiplatelet agents (such as regular aspirin, or the new strong antiplatelet drug clopidogrel), but only for asymptomatic patients with stenosis up to 50%, further treatment is generally recommended for patients with more than 75% stenosis. 2. Open carotid surgery. The basic method is endarterectomy to release arterial stenosis and atherosclerotic plaque, restore blood supply to the brain, and eliminate the source of cerebral infarction emboli. The procedure is relatively mature and has been carried out for more than 50 years. Because the procedure requires blocking the carotid artery on the side of surgery, the perioperative stroke and mortality rate for this procedure used to be about 5.6%. Now the procedure uses a diverter tube to remove the intimal plaque while maintaining the carotid blood supply during surgery, effectively reducing the perioperative stroke and mortality rate. The disadvantages of this procedure are the need for general anesthesia, large neck incision and trauma, and slow recovery. The advantages are complete removal of the hyperplastic intima and sclerotic plaque, less chance of reoccurrence of stenosis, and no need for lifelong antiplatelet and anticoagulant drugs. 3.Carotid artery endoluminal treatment. This is a method of applying balloon dilation and then placing stents in the narrowed carotid artery. This method has the advantages of small trauma, simple operation, fast onset of action, quick recovery, precise efficacy, and repeatable operation. Usually, a catheter with a diameter of about 2 mm is punctured at the root of the thigh under local anesthesia, placed into the femoral artery, delivered to the carotid artery stenosis, and then the balloon is dilated and then the stent is placed to complete the dilation of the carotid artery stenosis and improve the restoration of blood flow to the brain. The disadvantage is that the stent release process may induce the dislodgement of microscopic emboli of unstable plaque and cause “stroke” cerebral infarction, as well as vasospasm, intimal damage and the possibility of postoperative restenosis. In recent years, the use of stent systems with brain-protective filters has been introduced to prevent the capture of microscopic emboli that may be dislodged, effectively avoiding the occurrence of “stroke” cerebral infarction. When is treatment needed? Surgery or endoluminal treatment is needed when: 1. carotid stenosis exceeds 75%; 2. carotid stenosis is less than 75%, but the symptoms of cerebral ischemia such as dizziness and blackness are typical, or the sclerotic plaque is unstable and easily dislodged; 3. medication is not effective, there is a history of stroke attack, or there is still a small stroke attack after cerebral infarction. Precautions after surgery or endoluminal treatment? The recent results of carotid stenting are encouraging and patient acceptance is high. The results of many international trials comparing endarterectomy and stentoplasty have shown that carotid stentoplasty is safer, less invasive and faster to recover than endarterectomy. For patients who undergo endarterectomy, they need to take antiplatelet or anticoagulant drugs for about 36 months after the procedure, and lifelong anticoagulation and antiplatelet are not required. Metal stents are foreign bodies and have the potential for platelet aggregation and clot formation when in contact with blood in the body, so regular oral anticoagulation and antiplatelet medications are required after surgery. The usual medication is aspirin 100mg, 1 time/day, orally for life, and Bolivar (clopidogrel) 75mg, 1 time/day, orally for 3-6 months. Both of the above procedures need to be reviewed at 3, 6, 9 and 12 months postoperatively with carotid ultrasound or CT, and annually thereafter. Maintain good lifestyle habits after surgery: strict smoking cessation, light, low-salt, low-fat diet; active exercise; active control of blood pressure, blood glucose and blood lipid levels.