Will plaques in the carotid artery definitely cause a stroke?

Author: Jia Lingyun, Chief Physician, Xuanwu Hospital, Capital Medical University

Reviewer: Chief Physician of Huayang Capital Medical University Xuanwu Hospital

You may have heard that someone died of a stroke due to carotid plaque, and you may mistakenly believe that as long as you have carotid plaque, you will have a stroke. In fact, carotid plaque is only a triggering factor for stroke, not that having carotid plaque will definitely cause a stroke.

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1. Why does plaque form in the carotid artery?

The carotid artery is the "upstream" blood vessel that supplies blood to the brain. Under normal circumstances, the thickness of the carotid intima-media is less than 1.0 mm. When it is ≥1.5 mm, it is a carotid plaque, which is a manifestation of carotid atherosclerosis.

Some studies have shown that genetic factors have a certain impact on the formation of carotid artery plaques, and risk factors such as hypertension and diabetes also significantly promote the formation of plaques. Therefore, if a family member has a history of atherosclerotic plaques, they should pay attention to their lifestyle, control blood pressure, blood lipids, and blood sugar, quit smoking, limit alcohol, exercise appropriately, establish healthy living habits, and have regular physical examinations to achieve early screening and early prevention.

Excessive fatigue may also induce the formation of carotid artery plaques. When the body is in a state of long-term excessive fatigue, it will produce a large amount of "fatigue toxins" (also known as "free radicals"), which will damage the vascular endothelium and gradually form carotid artery plaques.

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Age, bad living habits and other factors are also risk factors for carotid artery plaques. Studies have shown that the older you are, the higher the incidence of carotid artery plaques, because hardened plaques are formed by the long-term effects of various damaging factors on the body.

2. Harm of carotid artery plaque

Carotid artery plaque is a necrotic lesion containing lipids and chloasma formed by damage to the carotid intima, lipid deposition, and hyperplasia and necrosis of smooth muscle cells, which can cause the following harms to the human body.

First, the detachment of carotid plaques can cause ischemia in the patient's intracranial arteries, which can lead to cerebral infarction. Carotid plaques are usually tightly attached to the wall of the carotid artery and do not move by themselves. However, if the patient has risk factors related to cerebrovascular disease and they are not well controlled, it may lead to rapid progression or rupture of the plaque, resulting in thrombosis. If the thrombus detaches in the brain, it will cause arterial embolism and may also cause ischemia in the intracranial arteries, leading to cerebral infarction.

Secondly, carotid artery plaques may rupture, causing local thrombosis and vascular occlusion.

Finally, carotid artery plaques can induce the occurrence of a variety of diseases, such as stroke, Alzheimer's disease, leukoaraiosis, etc.

3. Do carotid artery plaques require immediate surgical treatment?

After the carotid artery plaque is formed, is it necessary to undergo surgery immediately? This needs to be determined by observing the progression rate of the plaque.

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In most cases, if the plaque progresses slowly and remains stable under medical treatment, it will not cause any clinical symptoms and surgery is not required.

In a few cases, plaques progress rapidly and may cause clinical symptoms if not discovered in time or treated with appropriate medications. In this case, patients must seek medical attention in a timely manner and undergo ultrasound examinations to confirm the presence of vulnerable plaques and the degree of vascular stenosis.

If there is no improvement after standard drug treatment, and further clinical examination confirms the presence of plaque-related cerebral ischemia or stroke, the clinician should determine whether surgical treatment is needed.

Carotid plaques are a manifestation of carotid atherosclerosis, which is closely related to the occurrence of ischemic stroke, but not all carotid plaques will cause stroke. Modern medical research shows that vulnerable plaques (such as irregular morphology, ulcer plaques, intraplaque hemorrhage, etc.) may cause stroke.

Although carotid artery plaques do not necessarily cause stroke, the harm caused by carotid artery plaques is considerable. For the sake of your own health, you must have regular physical examinations to detect and treat related diseases early, especially the elderly, who should pay more attention.

References

[1] Lin Yusheng, Li Fayou, Yi Chenghui. Observation on carotid artery plaque formation caused by excessive labor in workers[J]. Trace Elements and Health Research, 2021, 38(3): 61-62.

[2] Ren Zhongxiu. Harm and prevention of carotid artery plaque[J]. Population and Health, 2021, 5: 91-94.