How does carotid artery plaque endanger our lives? What should we do?

Stroke is one of the most common diseases that endanger the lives of Chinese residents. If not actively controlled, as the disease progresses, severe cerebral infarction can lead to disability or even death of the patient. Therefore, carotid artery stenosis has become one of the "number one killers" that endanger people's health in today's society.

The main pathological basis of stroke is the formation of atherosclerotic plaques. If atherosclerotic plaques are not treated promptly and effectively, the plaques will gradually grow, causing the lumen of the carotid artery to gradually narrow until it is completely blocked. The main function of the carotid artery is to supply blood to the brain. If the carotid artery is narrowed or blocked, insufficient blood supply to the brain will occur, causing dizziness, memory loss, loss of orientation, impaired consciousness, blackouts, numbness and/or weakness on one side of the face and/or limbs, tongue deviation, difficulty in speaking, inability to understand what others say, etc.

But the above situation is not the most terrible. Because in the process of gradual growth of plaques and gradual narrowing of the carotid artery, if one side of the carotid artery is blocked, it can be compensated by the contralateral carotid artery and bilateral vertebral arteries, and there will also be collateral circulation, compensatory blood supply, and sometimes it may partially or even completely replace the function of the original blood vessels. Therefore, some patients found that a certain carotid artery was completely blocked during angiography, but the patients did not feel uncomfortable.

So what is the most terrible thing? For the carotid artery that has formed atherosclerotic plaques, the most terrible thing is acute thrombosis. If a thrombus forms in the plaque and its vicinity in a very short period of time and causes severe stenosis or even complete occlusion of the carotid artery, the nearby blood vessels will not have time to replace its blood supply, which will cause severe ischemia and necrosis of the brain, and this will cause acute cerebral infarction!

Simply put, an atherosclerotic plaque is a lot of cholesterol that gathers and gradually increases under the vascular endothelium, forming a bulge in the blood vessel cavity. Plaques are not exactly the same. If the outer skin of a plaque is very thick and solid (like a dumpling with thick skin and small filling), the surface is smooth and not easy to rupture, such a plaque will be less harmful; if the plaque is like a vulnerable plaque of the dumpling type with thin skin and large filling, such a plaque has great potential risks. As long as the plaque ruptures suddenly, a thrombus will quickly form at the rupture of the plaque and completely block the blood vessels in that area, resulting in acute cerebral infarction or even sudden death.

In addition to plaque rupture that can lead to acute thrombosis, "plaque erosion" is also one of the common causes of acute cerebral infarction. The so-called plaque erosion or erosive plaque is like some ingredients in the dumpling filling that penetrate into the dumpling skin, making the surface of the dumpling skin less smooth, and the appearance of some ingredients that should not appear. Erosive plaques can also induce thrombosis and lead to acute cerebral infarction.

Of course, there are some other rare cases of plaques causing cerebral infarction, such as calcified nodules, which will not be discussed in detail in this article.

To sum up, the most common process of acute cerebral infarction is: cholesterol enters the subendothelium of blood vessels → gradually accumulates to form plaques → plaques rupture or erode or form calcified nodules → thrombus formation at the plaque site → rapid occlusion of the carotid artery → cerebral ischemia, hypoxia and necrosis → acute cerebral infarction → failure to treat in time leads to more serious consequences.

What to do? How to prevent the above process? First, avoid too high cholesterol in the blood to reduce the raw materials for plaque formation; second, protect the integrity of the vascular endothelium (control blood pressure, blood sugar, quit smoking, etc.) to reduce the chance of cholesterol entering the vascular endothelium; third, use antiplatelet drugs such as aspirin to reduce the risk of local thrombosis after plaque rupture or erosion. If the above three points are achieved, the risk of cerebral infarction and stroke will definitely be greatly reduced.

As a patient, you must listen to your doctor, take medication accurately and long-term according to the doctor's instructions, and have regular check-ups. The development of the disease is usually uncontrollable. You must always pay attention to your lifestyle habits.

For patients with carotid artery stenosis exceeding 70% or stenosis of 50% with clinical symptoms, the incidence of cerebral ischemic events within 2 years is as high as 26% or more, even with effective drug treatment. Therefore, surgical treatment should be considered.

When the carotid artery stenosis is completely occluded, surgical treatment should be performed as soon as possible. In the case of complete occlusion, stripping and stenting are no longer possible, and cerebral vascular bypass treatment should be performed.

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