Do you know about the "threat" in the carotid artery - plaque?

This is the 5292th article of Da Yi Xiao Hu

Relatives often hold ultrasound reports and ask me: "What should I do if I find plaques in my carotid artery during my physical examination this year? Why do I have carotid artery plaques? Is it easy to cause a stroke? How should I treat carotid artery plaques? Do I need to take medicine? Can it be eliminated? What should I pay attention to in my daily life?"

In response to these issues, let’s talk about carotid artery plaque today.

1. What is carotid artery plaque?

Carotid plaque refers to substances deposited under the intima of the carotid artery, whose main components include cholesterol, lipids, calcium and some blood cells.

With the improvement of people's health awareness and the popularization of carotid ultrasound examination, the detection rate of carotid atherosclerotic plaques is getting higher and higher. According to surveys, about one-third of healthy people aged 40-54 years old have visible vascular atherosclerotic changes. In fact, carotid plaques have become a very common clinical problem.

Carotid artery plaque is a natural phenomenon of vascular aging and there is no need to panic.

2. What factors can cause carotid artery plaques?

There are many factors that lead to and promote the formation of carotid plaques, including uncontrollable factors such as age, gender, obesity, family history of cardiovascular and cerebrovascular diseases, as well as controllable factors such as high total cholesterol, high low-density lipoprotein cholesterol, high triglycerides, high blood pressure, high blood sugar, hyperuricemia, and high homocysteine. In addition, lifestyle habits such as smoking and drinking and high expression of certain inflammatory markers in the blood are also factors that promote carotid plaques. This shows that good living habits play an important role in slowing down the formation and development of carotid plaques.

3. Will carotid artery plaque definitely lead to cerebral infarction?

In fact, this is a common misunderstanding. The most important mechanisms for carotid artery plaques to cause ischemic stroke (also known as cerebral infarction) are as follows:

(1) Carotid artery plaque breaks off, forming emboli that flow into the cerebral vessels through the blood;

(2) Carotid artery plaques cause excessive vascular stenosis, resulting in insufficient blood supply to the distal cerebral vessels.

Regarding the above two mechanisms that lead to cerebral infarction, we also have two indicators to assess whether the carotid artery plaque is dangerous.

(1) Stability of carotid artery plaque

If the ultrasound report states that the plaque surface is not smooth, the shape is irregular, the plaque is low-echoic, or it is a mixed-echo plaque with low-echo as the main feature, it indicates that the plaque is unstable (also known as soft plaque or vulnerable plaque), indicating that the plaque is likely to rupture or fall off in the future, and the risk of cerebral infarction is high;

If ultrasound shows that the plaque has a smooth surface, regular shape and strong echoes, it indicates that it is a stable plaque (also known as a hard plaque), which means that the plaque is tightly attached to the vascular endothelium and is not easy to fall off, and the risk of cerebral infarction is relatively low.

(2) The degree of vascular stenosis caused by carotid artery plaque

If the degree of carotid artery stenosis is less than 50%, it is considered mild stenosis;

If the carotid artery stenosis is between 50% and 70%, it is considered moderate stenosis.

If the carotid artery stenosis is greater than 70%, it is considered severe stenosis.

The higher the degree of stenosis, the greater the risk of "cerebral infarction".

4. How to treat carotid artery plaque?

(1) Improve your lifestyle

Improve your diet, eat more fresh vegetables, fruits and whole grains, reduce the intake of high-fat foods, quit smoking, limit alcohol, increase exercise, control your weight, and ensure adequate sleep. At the same time, a good lifestyle is also the main way to prevent carotid artery plaques.

(2) Treatment of underlying diseases

High blood lipids, high blood pressure, and high blood sugar are important "accomplices" in the development of carotid artery plaques. If you want to prevent this troublesome problem of carotid artery plaques, the key is to control the "three highs". Controlling the "three highs" is the "core foundation" for preventing and treating carotid artery plaques.

(3) Interventional surgery

For most patients with carotid artery plaques, interventional surgery is not necessary. If the patient's carotid artery stenosis is greater than 70%, which has affected the normal blood supply to the brain, or if the patient's plaque type is unstable and produces symptoms such as movement disorders, blindness, and aphasia, then a professional evaluation is required to decide whether to undergo surgery. The main surgical methods currently include carotid endarterectomy and internal carotid artery stenting.

In short, we should treat carotid plaques correctly. We don’t need to be too nervous when we find carotid plaques. Through scientific drug treatment, lifestyle intervention and necessary surgical treatment, we can effectively manage and control the development of carotid plaques and protect the safety of our blood vessels.

Author: Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine

Dr. Chen Zhenghong, Department of Critical Care Medicine