Plaques in blood vessels are fundamentally the product of vascular aging.

Plaques in blood vessels are fundamentally the product of vascular aging.

Vascular endothelial damage is the initiating link in the development of atherosclerotic plaques, and low-density lipoprotein cholesterol (LDL-C) is a key factor in the development of atherosclerotic plaques.

Carotid artery plaques are very harmful, and more than half of strokes are related to them. After discovering carotid artery plaques, you need to pay special attention to the following 4 points.

1. What symptoms may be caused by further aggravation of carotid artery stenosis?

Most carotid artery plaques do not cause any symptoms. However, when the carotid artery stenosis worsens, it may cause dizziness, headache, memory loss, etc.

Symptoms of cerebral ischemia: dizziness, lightheadedness, tinnitus, memory loss, blurred vision, insomnia and nightmares.

Symptoms of ocular ischemia: decreased vision, hemianopsia, and amaurosis.

Transient ischemic attack: transient aphasia, hemiplegia, hemianopsia, etc., usually lasting for a few minutes. Most patients recover within 1 to 2 hours, and a few patients recover within 24 hours without leaving any sequelae.

2. How to determine whether carotid artery plaque requires intervention?

(1) Assess the nature of the plaque

Carotid artery plaques are divided into stable plaques and unstable plaques according to their stability. The latter is also called vulnerable plaques. Vulnerable plaques are atherosclerotic plaques that have a tendency to form blood clots or are very likely to quickly progress to "culprit plaques" and require great attention.

Stable plaques (hard plaques) have calcified and hardened, with a relatively thick fibrous cap on the surface, which is not easy to rupture and cause secondary thrombosis. This type of plaque generally causes blood vessel stenosis and blockage by growing continuously, affecting blood supply to the brain. However, the growth rate is not fast, and the risk of inducing stroke is relatively small.

Unstable plaques (soft plaques), pathologically, have the characteristics of thin fibrous cap, large lipid core, surface ulcer, neovascularization or bleeding in the plaque, etc. Unstable plaques are prone to rupture and secondary thrombosis. Once the thrombus blocks the carotid artery, or falls off and enters the intracranial artery with the blood flow, it will affect the blood supply to the brain and induce stroke.

The commonly used methods for detecting and identifying vulnerable plaques in clinical practice are divided into: invasive intracavitary imaging; non-invasive extracavitary imaging; and serum markers.

(2) Assess the degree of carotid artery stenosis caused by plaque

"2019 ESC/EAS Dyslipidemia Management Guidelines": Carotid artery ultrasound is recommended to assess atherosclerotic cardiovascular disease (ASCVD).

If the high-risk factors of carotid plaques are not well controlled, the volume of plaques will continue to grow, causing carotid lumen stenosis, which can easily lead to blood flow blockage, cerebrovascular disease and other risks. In general, severe carotid stenosis (stenosis ≥ 70%) is treated surgically if necessary according to the condition.

3. Can carotid artery plaque be reversed?

The root cause of the appearance of atherosclerotic plaques is damage to the vascular endothelium. It is generally believed that apart from surgery, it is only possible to slow down or stop its growth, but it is almost impossible to eliminate it.

The expert consensus of the European Atherosclerosis Society (EAS) in 2017 stated that the lower the low-density lipoprotein cholesterol (LDL-C) level, the smaller the volume of atherosclerotic plaques, and the slower or even reversed the progression of plaques.

However, the "disappearance" of plaques may be temporary, and plaques may still reappear as the human body ages.

4.How to reduce vascular endothelial damage?

The first step to inhibit plaque growth is to reduce or avoid damage to the vascular endothelium.

Diseases such as high blood lipids, high blood pressure, diabetes and bad living habits such as smoking, drinking and staying up late can lead to the formation or aggravation of plaques. Therefore, we should stay away from tobacco, improve our living/eating habits, and take medicines as prescribed by doctors to minimize the damage to blood vessels caused by these risk factors.

In addition, supplementing vitamin P and anthocyanins and eating more eggplant, cherries, lemons, purple sweet potatoes, black rice, grapes, mulberries, etc. can help protect the vascular endothelium.