Recently, 45-year-old Mr. Xu was in a bad mood when he received the physical examination report. It turned out that the unit’s annual physical examination arranged carotid artery ultrasound examination for employees over 45 years old, and Mr. Xu was found to have carotid artery plaque. He checked online and learned that carotid artery plaques are closely related to cerebral infarction, which made him very worried: Why do carotid arteries develop plaques? Will the plaque fall off? Is it blocked in the brain? Is it a cerebral infarction? How to treat it? At the end of the year, many units organize physical examinations for employees, and neurology outpatient doctors often encounter consultants like Mr. Xu.
Zhou Nina, director and chief physician of the second department of cerebrovascular neurology at Hunan Provincial Brain Hospital (Hunan Provincial Second People’s Hospital), reminded that carotid artery plaque is a natural process of blood vessel aging, just like scale growing on the walls of water pipes that have been used for a long time. Similarly, you don’t need to be too nervous when you find carotid artery plaque, but you must actively control risk factors and receive active treatment under the guidance of a doctor, which is crucial to the prevention and treatment of cardiovascular and cerebrovascular diseases.
Carotid artery plaque is closely related to stroke, and high-risk groups should be screened regularly
The carotid artery is the artery located in the neck. On the side of the neck, there is a main trunk of the carotid artery (common carotid artery) on the left and right, and then it continues up from the neck to the head. The carotid artery carries blood from the heart to the head, face, and neck, and is one of the main blood vessels that supplies blood to the brain. Its main function is to provide fresh blood and oxygen to the brain to maintain normal brain function.
Carotid artery plaque is also called carotid atherosclerotic plaque. Simply put, its formation principle is that blood flows in blood vessels for many years, and some lipids in the blood slowly deposit on the wall of the vessel, just like when we burn The water kettle has a lot of scale deposited in it.
Studies have shown that the incidence rate of carotid artery plaques in people over 40 years old is 40% to 45%. As age increases, the incidence rate increases. People over 60 years old have varying degrees of carotid artery plaques. In addition to age factors, high blood pressure, hyperlipidemia (especially high low-density lipoprotein cholesterol), hyperglycemia, smoking, alcohol abuse, lack of exercise, obesity, hyperhomocysteinemia, hyperuricemia, etc., are also Risk factors for carotid plaque.
The harm of carotid atherosclerotic plaques should not be underestimated. It can cause a decrease in blood vessel elasticity; plaque enlargement can cause lumen stenosis, causing dizziness, fatigue and other symptoms of insufficient blood supply to the brain; unstable plaque rupture and falling off can cause deficiency. The occurrence of hemorrhagic stroke. Since stenosis and occlusion caused by carotid plaques are important causes of ischemic stroke, early detection of carotid plaques, especially unstable plaques, is very important for the prevention and treatment of stroke.
The carotid artery is one of the sites where atherosclerosis is prone to occur, and because the carotid artery is superficial and easy to detect with ultrasound, carotid artery plaque can be used as a “window” to understand systemic atherosclerosis. If plaques appear in the carotid arteries, it also reflects that similar lesions may occur in systemic arteries (such as coronary arteries, renal arteries, lower limb arteries, etc.), which may lead to angina pectoris, hypertension, lower limb pain, intermittent claudication, etc. Zhou Nina recommends that people over 60 years old, or people with high risk factors such as high blood pressure, hyperglycemia, hyperlipidemia, and obesity, should have a carotid artery ultrasound examination once a year.
Hypoechoic and uneven echo often indicate plaque instability, and early intervention is needed
Hyperechoic, isoechoic, hypoechoic; regular plaques, ulcerative plaques… After receiving the physical examination results, many people look at the various terms and do not understand the meaning behind them. Zhou Nina explained that in carotid artery ultrasound examination, carotid artery plaques are divided into hyperechoic, isoechoic, hypoechoic and heterogeneous echogenic plaques based on the acoustic characteristics of the plaques; based on the morphological characteristics of the plaques, carotid artery plaques are divided into Divided into regular plaques, irregular plaques and ulcerated plaques. Hypoechoic, heterogeneous echogenic plaques containing large lipid cores, thin fibrous caps, or bleeding within the plaques often indicate unstable plaques and vulnerable plaques, commonly known as “soft plaques” or ulcerated plaques. Plaques are also vulnerable plaques; hyperechoic and isoechoic plaques have more calcification or are rich in fibrous components, indicating that the plaques are more stable.
Increased carotid plaque can cause vascular stenosis. Carotid artery ultrasound divides vascular stenosis caused by carotid plaque into three levels: less than 50% is mild, 50% to 69% is moderate, and 70% to 99% is moderate. severe. The degree of stenosis also provides a basis for the treatment of carotid plaque.
Zhou Nina suggested that if unstable plaques are found through carotid artery ultrasound examination, or the blood vessel stenosis exceeds 50%, you should go to the neurology department for further examination as soon as possible, and a specialist will guide intervention and treatment; if stable carotid artery plaques are found, Pay attention to regular re-examinations, once every six months in the first two years, to observe whether the plaques have increased and whether they are stable. If the plaques remain unchanged within two years, the re-examination can be extended to once a year.
Actively improve your lifestyle and choose medications and surgical treatments according to the situation
Recently, 58-year-old Mr. Zhang found that his eyesight was declining while playing mahjong, and he made several mistakes in the “nine barrels” and “eight lines”. Under the persuasion of a friend, he underwent a physical examination and found carotid artery plaque, which had caused severe stenosis of the carotid artery. At the Hunan Provincial Brain Hospital (Hunan Provincial Second People’s Hospital), after discussions between doctors, Mr. Zhang and his family, it was finally decided to use carotid endarterectomy for treatment. After surgical treatment, Mr. Zhang’s vision was restored and problems such as dizziness and dark eyes were resolved.
What treatments are available for carotid plaque? Under what circumstances is surgical treatment recommended? Zhou Nina said that carotid plaques are divided into symptomatic and asymptomatic according to the presence or absence of neurological symptoms or vascular events. Symptomatic carotid plaque refers to the occurrence of transient ischemic attack or ischemic stroke, which may cause transient or persistent vision loss, visual field loss, weakness or numbness of the contralateral limb, and sudden onset of bilateral or ipsilateral vision loss. Symptoms include impaired consciousness, slurred speech, and unsteady walking. If the above situation has not occurred, or if there are only non-specific symptoms such as dizziness and fatigue, it is asymptomatic carotid plaque.
Zhou Nina suggested that once carotid artery plaque is discovered, regardless of whether there are symptoms or not, the first step is to improve lifestyle and control risk factors. Eat a reasonable diet (light, low-salt and low-fat diet), exercise moderately, quit smoking and limit alcohol, control your weight, maintain good living habits (don’t stay up late), and control blood pressure, blood sugar, and blood lipids within normal ranges.
The main drug treatment for carotid plaques is lipid-lowering drugs, which doctors will choose according to the patient’s specific conditions. Patients with many basic cardiovascular and cerebrovascular diseases need to take lipid-lowering drugs to stabilize plaques and reduce LDL cholesterol to an even lower level, regardless of whether their blood lipids are abnormal or not.
When carotid artery plaque causes severe vascular stenosis, in addition to drug treatment, surgical treatment, including carotid endarterectomy and carotid artery stent implantation, can also be performed. Generally speaking, when the degree of vascular stenosis is ≥70%, doctors need to fully evaluate the benefits and risks of surgery before considering whether to undergo surgery.