Focus on screening to prevent carotid artery stenosis

Focus on screening to prevent carotid artery stenosis

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All the arteries in the human body are connected, like a long pipe. Therefore, when atherosclerosis occurs in one place, atherosclerosis is likely to occur in arteries throughout the body, but the severity of the occurrence varies in different locations. For example, if it occurs in the carotid arteries, it will cause carotid artery stenosis, and if it occurs in the coronary arteries, it will cause coronary heart disease. Therefore, arterial stenosis and coronary heart disease often go hand in hand.

The carotid arteries are on the left and right sides of the neck. You can feel the pulsation of the carotid arteries by running your fingers along the angle of the mandible against the skin. The carotid artery is the main blood supply artery to the human brain. If this artery is narrowed due to atherosclerosis, the blood supply to the brain will be affected. Once the atherosclerotic plaque ruptures and forms a thrombus, the emboli will enter the brain along with the blood flow and get stuck in the small cerebral blood vessels, causing cerebral infarction. Studies have found that 25%-30% of cerebral infarctions are related to carotid artery stenosis.

Carotid atherosclerosis can lead to carotid artery stenosis and even cerebral infarction. This pathological process is exactly the same as coronary atherosclerosis causing coronary artery stenosis, leading to coronary heart disease and myocardial infarction. In fact, this is the manifestation of atherosclerosis in different blood vessels throughout the body. Therefore, carotid artery stenosis and coronary heart disease are “suffering brothers.”

Studies have found that the greater the number of coronary diseased vessels, the higher the detection rate. Patients with carotid stenosis also have a higher prevalence of coronary heart disease.

Coronary heart disease combined with carotid artery stenosis makes treatment more difficult. For patients with severe carotid stenosis who undergo coronary artery bypass surgery or other surgeries, the risk of stroke is significantly increased before and after surgery; for patients with severe coronary stenosis who undergo carotid endarterectomy or carotid stenting, the risk of stroke before and after surgery is The risk of acute myocardial infarction is also significantly higher than that of ordinary patients. If you have severe carotid artery stenosis, doctors generally recommend carotid artery revascularization before performing surgery other than heart surgery to avoid severe brain ischemia after surgery.

Therefore, it is very important to focus on simultaneous screening of arterial stenosis and coronary heart disease. Patients who have been diagnosed with coronary heart disease need to undergo carotid artery ultrasound examination; patients who have been diagnosed with carotid artery stenosis should pay attention to whether they have a history of coronary heart disease, and conduct electrocardiogram, treadmill exercise test or coronary CT examination as appropriate. The more severe the confirmed arterial stenosis and the more lesions there are, the more comprehensive and in-depth examination of another artery is needed.

If you are over 40 years old and also have smoking, high blood pressure, hyperlipidemia, reduced exercise, emotional stress, etc., you are not only a high-risk group for coronary heart disease but also a high-risk group for carotid artery stenosis, and you should have a test every six months or one year. A relevant disease screening.

If coronary heart disease and carotid artery stenosis coexist, treatment strategies need to be determined based on both conditions. If the condition is relatively stable and the degree of stenosis is not severe, drug treatment and follow-up observation can be used. At the same time, risk factors that lead to atherosclerosis, such as hyperlipidemia, diabetes, and hypertension, must also be actively controlled. If one of the symptoms is more obvious and the condition is more severe, surgical treatment of the more serious lesion can be considered while taking into account the safety of the other lesion. For example, if symptoms of coronary heart disease predominate, coronary revascularization should be performed first.

If the symptoms of coronary heart disease and carotid stenosis are severe, patients who are suitable for coronary intervention and carotid artery stent surgery will generally undergo coronary intervention first, and elective carotid artery stent surgery will be performed after the condition is stable. If both conditions are unstable and multidisciplinary consultation is required to evaluate the patient’s condition, carotid and coronary revascularization may be considered in one operation.

(The author is chief physician of the Department of Cardiovascular Medicine, Peking University People’s Hospital)

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