The carotid artery is one of the early predisposing sites of atherosclerosis.
The extracranial segment of the carotid artery is superficial and easy to detect.
Therefore, the carotid artery plaque can be used as a "window" reflecting systemic atherosclerosis
.

From birth, people have yellow lipid dots in their carotid arteries, and as they age, more and more lipids deposit with blood components to form plaques

The carotid artery is one of the early predisposing sites of atherosclerosis.

 

 

A large proportion (50-70%) of strokes are caused by carotid plaques
.

With the progression of the carotid artery plaque, some (20-30%) of the plaques eventually progress to stroke.

A large proportion (50-70%) of strokes are caused by carotid plaques

 

 

Therefore, two risk factors that we should focus on are stenosis and plaque vulnerability
.

Therefore, two risk factors that we should focus on are stenosis and plaque vulnerability
.

For health, the concept of attaching importance to prevention has gradually deepened.
Early detection of stroke-related risk factors and attention to prevention can reduce the incidence of stroke, which has become a common strategy
.

It has become a consensus that carotid plaque is an important risk factor for stroke

For health, the concept of attaching importance to prevention has gradually deepened.

Screening methods for carotid plaque

At present, the main content of carotid plaque screening is neck ultrasonography, which is a preliminary screening and is widely popular because it is simple, economical, and non-invasive
.

Carotid ultrasound is only a window, which reflects the degree of arteriosclerosis to a certain extent

At present, the main content of carotid plaque screening is neck ultrasonography, which is a preliminary screening and is widely popular because it is simple, economical, and non-invasive

Carotid plaque screening should include neck high-resolution MR in addition to neck ultrasound

Carotid plaque screening should include neck high-resolution MR in addition to neck ultrasound

High-resolution MR imaging of the neck, the use of 8-channel carotid plaque special magnetic resonance coil can significantly improve the signal-to-noise ratio and contrast of carotid plaque imaging, which is conducive to the accurate diagnosis of plaque properties and helps to accurately identify vulnerable plaques (or unstable plaque)
.

High-resolution MR imaging of the neck, the use of 8-channel carotid plaque special magnetic resonance coil can significantly improve the signal-to-noise ratio and contrast of carotid plaque imaging, which is conducive to the accurate diagnosis of plaque properties and helps to accurately identify vulnerable plaques (or unstable plaque)
.

Precise diagnosis

MRI can evaluate most characteristics of vulnerable plaques:

MRI can evaluate most characteristics of vulnerable plaques:

(1) The degree of stenosis

(1) The degree of stenosis

(2) total plaque volume,

(2) total plaque volume,

(3) Plaque components

(3) Plaque components

(4) Plaque surface morphology, including ulceration and fibrous cap rupture, can dynamically monitor plaque evolution
.

(4) Plaque surface morphology, including ulceration and fibrous cap rupture, can dynamically monitor plaque evolution
.

 

 

Stroke prevention should focus on preventing carotid artery problems.
Carotid artery plaque screening is necessary, but it must be reasonably standardized!

Stroke prevention should focus on preventing carotid artery problems.
Carotid artery plaque screening is necessary, but it must be reasonably standardized!

Asymptomatic carotid stenosis (aCAS) is an important risk factor for stroke
.

Asymptomatic carotid stenosis (aCAS) is an important risk factor for stroke
.

Medical and surgical treatment of moderate-to-severe aCAS may reduce the risk of aCAS-related stroke, but is carotid artery screening necessary in the general population?

Medical and surgical treatment of moderate-to-severe aCAS may reduce the risk of aCAS-related stroke, but is carotid artery screening necessary in the general population?

The 2017 European Society for Vascular Surgery (ESVS) guidelines also do not recommend screening for aCAS in the general population, but selective screening may be considered for patients with multiple risk factors for vascular disease (eg, peripheral arterial disease).
The purpose of screening is not to identify patients with possible surgical treatment, but to identify patients with aCAS screened through risk factor management and Drug therapy reduces late cardiovascular and cerebrovascular complications and mortality
.

The 2017 European Society for Vascular Surgery (ESVS) guidelines also do not recommend screening for aCAS in the general population, but selective screening may be considered for patients with multiple risk factors for vascular disease (eg, peripheral arterial disease).
The purpose of screening is not to identify patients with possible surgical treatment, but to identify patients with aCAS screened through risk factor management and Drug therapy reduces late cardiovascular and cerebrovascular complications and mortality
.
guideline management

Therefore, extensive screening of carotid plaques in asymptomatic populations needs reasonable regulation
.

Therefore, extensive screening of carotid plaques in asymptomatic populations needs reasonable regulation
.

We first need to emphasize that carotid artery screening is not suitable for mass screening in populations
.
Carotid ultrasonography is uncontroversial if the patient presents with symptoms or has had a cardiac stent placed
.

We first need to emphasize that carotid artery screening is not suitable for mass screening in populations
.
Carotid ultrasonography is uncontroversial if the patient presents with symptoms or has had a cardiac stent placed
.

On the one hand, the screening of the general population needs to consider the issue of cost-effectiveness.
On the other hand, screening may lead to the discovery of a large number of people with carotid intimal thickening to go to the hospital for small plaques, but in fact doctors have no special treatment options, but may not be acceptable to patients without treatment
.

On the one hand, the screening of the general population needs to consider the issue of cost-effectiveness.
On the other hand, screening may lead to the discovery of a large number of people with carotid intimal thickening to go to the hospital for small plaques, but in fact doctors have no special treatment options, but may not be acceptable to patients without treatment
.

ACS patients are a potentially high-risk population for stroke, especially in people >60 years of age
.
Rational examination and intervention of ACS patients is of great significance for the prevention and treatment of ischemic stroke

ACS patients are a potentially high-risk population for stroke, especially in people >60 years of age
.
Rational examination and intervention of ACS patients is of great significance for the prevention and treatment of ischemic stroke

"Chinese Stroke Society Scientific Statement on Screening for Asymptomatic Carotid Stenosis"

"Chinese Stroke Society Scientific Statement on Screening for Asymptomatic Carotid Stenosis"

1.
Routine carotid artery screening is not recommended in the general population (class III recommendation, level of evidence C)
.
Studies in the Chinese population are needed to clarify the safety and efficacy of carotid artery screening, and to carry out health economic evaluations
.

1.
Routine carotid artery screening is not recommended in the general population (class III recommendation, level of evidence C)
.
Studies in the Chinese population are needed to clarify the safety and efficacy of carotid artery screening, and to carry out health economic evaluations
.

2.
It may be reasonable to perform carotid artery screening in high-risk groups of aCAS (eg, males, age over 60 years, combined with 2 or more major risk factors for stroke) (class IIb recommendation, level of evidence C)
.

2.
It may be reasonable to perform carotid artery screening in high-risk groups of aCAS (eg, males, age over 60 years, combined with 2 or more major risk factors for stroke) (class IIb recommendation, level of evidence C)
.

3.
For patients with moderate or higher aCAS (stenosis ≥50%), the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) should be further assessed, and the best medical treatment should be given, including statins and (or) Antiplatelet drugs, management of risk factors such as hypertension and diabetes mellitus
, and comprehensive interventions for healthy life>

3.
For patients with moderate or higher aCAS (stenosis ≥50%), the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) should be further assessed, and the best medical treatment should be given, including statins and (or) Antiplatelet drugs, management of risk factors such as hypertension and diabetes mellitus
, and comprehensive interventions for healthy life>high blood pressure diabetes

4.
For patients with severe aCAS (stenosis ≥ 70%), in the case of life expectancy > 5 years, it is recommended to perform CEA or CAS in qualified hospitals (the incidence of perioperative stroke and death < 3%) (class II recommendation).
, Level B evidence)
.

4.
For patients with severe aCAS (stenosis ≥ 70%), in the case of life expectancy > 5 years, it is recommended to perform CEA or CAS in qualified hospitals (the incidence of perioperative stroke and death < 3%) (class II recommendation).
, Level B evidence)
.

5.
It is necessary to strengthen and standardize the technical training of carotid ultrasound, CEA and CAS under the organization of professional societies
.

5.
It is necessary to strengthen and standardize the technical training of carotid ultrasound, CEA and CAS under the organization of professional societies
.

6.
It is necessary to vigorously carry out public health education on aCAS management

6.
It is necessary to vigorously carry out public health education on aCAS management

Summarize

Summarize

Carotid plaque is not the only cause of stroke, but it is an important cause
.
With or without stenosis, with or without plaque, attention should be paid to controlling risk factors, including life>
.
That's where our focus is.
Controlling the risk factors for stroke is the most important treatment
.
Such as appropriate increase in exercise, reasonable diet, weight loss, smoking cessation, no alcoholism, control of blood pressure, blood sugar, blood lipids,
etc.
Treatment options include health management, medication, and surgery
.
Carotid artery screening is an important window.
If it is positive, follow-up should be continued, and the life>
.

Carotid plaque is not the only cause of stroke, but it is an important cause
.
With or without stenosis, with or without plaque, attention should be paid to controlling risk factors, including life>
.
That's where our focus is.
Controlling the risk factors for stroke is the most important treatment
.
Such as appropriate increase in exercise, reasonable diet, weight loss, smoking cessation, no alcoholism, control of blood pressure, blood sugar, blood lipids,
etc.
Treatment options include health management, medication, and surgery
.
Carotid artery screening is an important window.
If it is positive, follow-up should be continued, and the life>
.
references:

[1] Poorthuis MHF, Sherliker P, Morris DR, et al.
Eur J Vasc Endovasc Surg.
2021 Mar;61(3):365-373.

[1] Poorthuis MHF, Sherliker P, Morris DR, et al.
Eur J Vasc Endovasc Surg.
2021 Mar;61(3):365-373.

[2] Keyhani S, Cheng EM, Hoggatt KJ, et al.
JAMA Neurol.
2020 Sep 1;77(9):1110-1121.
 

[2] Keyhani S, Cheng EM, Hoggatt KJ, et al.
JAMA Neurol.
2020 Sep 1;77(9):1110-1121.
  JAMA

[3] Howard DPJ, Gaziano L, Rothwell PM; Oxford Vascular Study.
Lancet Neurol.
2021 Mar;20(3):193-202.

[3] Howard DPJ, Gaziano L, Rothwell PM; Oxford Vascular Study.
Lancet Neurol.
2021 Mar;20(3):193-202.

[4] Keyhani S, Cheng EM, Hoggatt KJ, et al.
JAMA Neurol.
2020 Sep 1;77(9):1110-1121.
 

[4] Keyhani S, Cheng EM, Hoggatt KJ, et al.
JAMA Neurol.
2020 Sep 1;77(9):1110-1121.
 

[5] Reiff T, Eckstein HH, Mansmann U, et al.
Int J Stroke.
2019 Mar 15;15(6):1747493019833017.

[5] Reiff T, Eckstein HH, Mansmann U, et al.
Int J Stroke.
2019 Mar 15;15(6):1747493019833017.

[6] Högberg D, Mani K, Wanhainen A, et al.
Eur J Vasc Endovasc Surg.
2018 Jun;55(6):819-827.

[6] Högberg D, Mani K, Wanhainen A, et al.
Eur J Vasc Endovasc Surg.
2018 Jun;55(6):819-827.

[7] Chinese Stroke Society Scientific Statement Expert Group.
Chinese Stroke Society Scientific Statement on Screening for Asymptomatic Carotid Stenosis[J].
Chinese Journal of Medicine, 2022, 102(3): 175-179.
DOI: 10.
3760/cma .
j.
cn112137-20210728-01674.

[7] Chinese Stroke Society Scientific Statement Expert Group.
Chinese Stroke Society Scientific Statement on Screening for Asymptomatic Carotid Stenosis[J].
Chinese Journal of Medicine, 2022, 102(3): 175-179.
DOI: 10.
3760/cma .
j.
cn112137-20210728-01674.

 

leave a message here