The true face of carotid stenosis.
Can cause a variety of diseases
Carotid stenosis, a condition that can cause strokes or transient ischemic attacks, is a narrowing and occlusion of the common and internal carotid arteries. It is like a traffic jam that begins to occur on a major traffic lane. One of the causes of stenosis is the accumulation of plaque, a deposit in the blood, which is known medically as atherosclerosis.
Asymptomatic carotid artery stenosis
Symptomatic carotid artery stenosis
Hypertension, hyperlipidemia, diabetes and smoking are all culprits in carotid artery stenosis, especially the "terrorist" of hypertension. Therefore, one of the priorities of prevention is to control blood pressure. By keeping blood pressure within normal limits, cerebrovascular disease caused by carotid stenosis can be effectively alleviated. Encouraging smoking cessation can also help to prevent carotid artery stenosis from causing the corresponding disease.
(ii) Transient blackout: a sudden loss of vision lasting from a few seconds to several hours, which is a characteristic symptom of carotid stenosis.
(iii) Mild, non-disabling strokes caused by the affected intracranial vessels.
Once symptoms such as the above appear, whether mild or severe, they must be taken seriously. Then, we should cooperate with the doctor for the appropriate examination.
5 Tests for Carotid Artery Stenosis
All patients with carotid stenosis are subjected to a neurological physical examination, which is to make further diagnosis based on the state of expression, facial symmetry, speech, consciousness, motor function, limb tone, ataxia test, sensory function, etc. Some patients may be detected with signs of stroke.
The doctor will also perform carotid ultrasound, CT angiography (CTA), MRI, and cerebral angiography to determine the exact location and extent of carotid artery stenosis. These sound like very complex operations, and we have a general idea of how these specialized diagnostic methods are performed.
Ultrasonography, the clinical test of choice to screen for carotid stenosis, can diagnose the site and extent of arterial stenosis or occlusion. Moreover, ultrasonography is non-invasive, low cost and reproducible. The disadvantage is that it cannot be accurately quantified for multiple stenoses and may overestimate the degree of stenosis.
Magnetic resonance imaging angiography (MRA) can show the anatomical site and degree of carotid stenosis, but this test is not indicated if the patient has a ferromagnetic metal implant in the body, such as a pacemaker or the like.
CT examinations include coronary CT examinations (CTA) and CT perfusion scans (CTP).CTA provides anatomic and morphologic information on the aortic arch, supra-arch vascular openings, and carotid arteries to assess the degree and location of stenosis in the carotid arteries.CTP obtains perfusion information on blood flow in the brain.
DSA is the "gold standard" for the diagnosis of carotid stenosis. Unlike CT and MR, DSA is invasive and requires hospitalization in the operating room under local anesthesia. DSA is useful for observing the type of aortic arch, the nature of the carotid stenosis, such as the site of stenosis, the degree of stenosis, the overall pattern of the plaque, or the presence of ulceration of the plaque, as well as the integrity of the contralateral carotid artery, vertebral artery, and the intracranial ring of Willis. If the patient is likely to undergo interventional treatment, non-invasive examinations such as CT are preferred, and angiography is performed after admission to clarify the site and nature of the lesion, followed by interventional treatment at the same time.
(ii) Moderate stenosis is a 30%-69% reduction in the internal diameter of the artery.
(iii) Severe stenosis is a 70%-99% reduction in the internal diameter of the artery.
④ Complete occlusion is a pre-occlusive state with >99% stenosis.
Therapeutic measures for unblocking stenosis
Control blood pressure, blood sugar, blood lipids, and get regular medical checkups.
1. repeat antihypertensive drugs as prescribed, blood pressure control target: <140/90 mmHg. antiplatelet and anticoagulant therapy, antiplatelet drugs available include aspirin, clopidogrel, etc. Low-dose aspirin (75-150 mg/d) can be as effective as higher doses; aspirin combined with clopidogrel reduces the incidence of cardiovascular events, and the risk of bleeding should be guarded against. The use of conventional anticoagulants, such as warfarin, in combination with aspirin does not reduce the incidence of cardiovascular events and may increase the risk of major bleeding. The readers here need to be reminded that medication must be strictly followed and taken under the guidance of a doctor so that the disease is cured rather than causing more serious consequences.
1. Eat more vegetables and fruits and foods containing high quality protein.
The use of carotid endarterectomy (CEA) or carotid stenting (CAS), in addition to antiplatelet and statin medications, strict blood pressure and glucose control, and smoking cessation, can further reduce the incidence of ischaemic stroke events. CAS is a relatively less invasive treatment that can be performed under local anesthesia.
Prognostic care for carotid artery stenosis
and daily prevention
Careful daily care and proven health education can maximize the ability of patients with carotid stenosis to recover and return to their daily lives sooner. So if we are in the position of caring for a patient with carotid stenosis, what are the key points of prognostic care that we should know? Broadly speaking, there are three areas that should be addressed.
Daily medication and diet
Disease monitoring in daily life
Life Health Management
Editor: Guo Lei