I secretly told everyone that the content of today's article is super strong Oh, be sure to see the end.
Diseases are the main factors that jeopardize the health of human beings, many people in their ordinary lives are not too aware of the general knowledge of the disease, want to treat each disease first of all to understand more about the cause! Many people are now suffering from carotid artery stenosis, do you know what are the symptoms of carotid artery stenosis? The carotid artery stenosis how to do it, the following and the editorial take a look at the carotid artery stenosis treatment details!
Table of Contents
1, carotid artery stenosis overview 2, carotid artery stenosis clinical manifestations
3, carotid artery stenosis characteristics of the treatment 4, carotid artery stenosis of the common causes
5, carotid artery stenosis symptoms 6, carotid artery stenosis harm
7, carotid artery stenosis need to do the examination 8, carotid artery stenosis of the surgical indications
8, the carotid artery stenosis /p>
Overview of carotid artery stenosis
The carotid artery is a large blood vessel that transports blood from the heart to the head, face, and neck, and it is one of the main blood vessels supplying the brain. According to the literature, patients with severe carotid artery stenosis, even with effective medication to control, the incidence of cerebral ischemic events within 2 years is as high as 26% or more; and more than 60% of cerebral infarction is due to carotid artery stenosis, and severe cerebral infarction can lead to disability or even death. Therefore, carotid artery stenosis has become one of the "number one" health hazards in today's society.
Disease etiology
Multiple causes can lead to carotid artery stenosis, and the characteristics of carotid artery stenosis are different for different causes.
Atherosclerosis
Atherosclerosis is the most common cause of carotid artery stenosis in middle-aged and elderly patients. Patients are often accompanied by hypertension, diabetes, hyperlipidemia, obesity, smoking and other risk factors that can lead to cardiovascular damage. Atherosclerosis is due to the accumulation of lipid material in the blood vessel wall, and the macrophage phagocytosis of lipid material within the blood vessel wall to form lipid pools, accompanied by lipid pools on the surface of the formation of fibrous cap, lipid core and fibrous cap constitutes the arterial wall of the atherosclerotic plaques of the main components. The gradual increase of plaque makes the lumen gradually narrow, or plaque instability, rupture occurs, the lipid content of the plaque is exposed in the lumen of the blood vessel, resulting in the formation of platelets thrombus, thrombus dislodgement. Both can lead to the occurrence of cerebral ischemic events. Atherosclerosis-induced carotid stenosis is often located at the end of the common carotid artery, the beginning of the internal carotid artery, the internal carotid artery siphon, and the end of the internal carotid artery is divided into the anterior and middle cerebral arteries.
Carotid artery entrapment
The carotid artery consists of an intima-media layer, a smooth muscle layer, and a tunica-media layer, which are normally connected to each other as a unified whole, and the blood flows in the lumen surrounded by the wall of the blood vessel. The so-called arterial entrapment, as the name suggests, is a separation of the layers of the vessel wall due to the entry of blood between the layers for various reasons. In community-based surveys in the United States and France, the incidence of carotid artery entrapment is 2.5-3 per 100,000, and carotid artery entrapment is responsible for up to 25% of strokes in young patients under 45 years of age.
Vascular lesions related to development, inflammation, or autoimmunity
Other lesions related to development, vascular inflammation, and autoimmunity can also lead to carotid artery stenosis, but only in a very small percentage of cases. Examples include aortitis, fibromuscular dysplasia, and smog disease. A larger proportion of these patients are young.
Clinical manifestations of carotid artery stenosis
Some patients with mild to moderate carotid artery stenosis may have no clinical symptoms. Those who develop clinical symptoms related to stenosis are called "symptomatic carotid stenosis".
The clinical manifestations of symptomatic carotid stenosis are mainly related to cerebral ischemia caused by stenosis. Depending on the time of onset, they can be categorized as transient ischemic attacks and strokes, and the main difference between the two is whether or not the patient's ischemic symptoms resolve completely within 24 hours. A transient ischemic attack is characterized by complete resolution, while a stroke is characterized by incomplete resolution.
Ischemic symptoms due to carotid artery stenosis include dizziness, memory, disorientation, impaired consciousness, blackouts, numbness and/or weakness in the side and/or limbs, tongue deviation, speech problems, and inability to understand what is being said.
Diagnosis and differential diagnosis
Diagnosis
The diagnosis of carotid artery stenosis is mainly based on the patient's clinical symptoms, physical examination as well as imaging examinations. At present, the imaging methods mainly used in the clinic include the morphological examination of blood vessels and the examination of brain tissues, while the imaging study of the nature of plaque and blood rheology is the future research direction.
Vascular imaging methods
At present, the main carotid artery imaging methods include carotid ultrasound, transcranial color Doppler, CT angiography (CTA), and digital subtraction angiography (DSA). Among them, DSA is the "gold standard" for examination.
Brain imaging
Brain tissue ischemic changes caused by carotid artery stenosis, currently the main application of clinical brain tissue examination for computed tomography (CT), magnetic **** vibration (MRI) scanning and diffusion weighted imaging (DWI).
In addition to this, there are currently available clinical plaque characterization methods based on MRI, which mainly refer to multi-sequence MRI, utilizing the sensitivity of different scanning sequences of MRI to different tissues, to detect the main component characteristics of plaques. However, it has not yet been popularized in clinical practice.
Differential diagnosis
The differential diagnosis of carotid artery stenosis mainly includes symptomatic differentiation and site differentiation. Symptomatically, it is mainly associated with other intracerebral lesions such as intracranial space, seizures and other cerebrovascular diseases. The identification of the site refers to the need to determine whether carotid artery stenosis is the "responsible vessel" for cerebral ischemia when combined with other stenotic diseases.
Treatment
Treatment of carotid stenosis includes risk factor control, medication, surgery, and intervention.
Risk factor control
Atherosclerotic carotid stenosis is often part of a systemic vascular disease. Therefore, controlling the risk factors that can lead to vascular atherosclerosis is the basis of carotid stenosis treatment. It mainly includes: proper exercise, weight control, avoiding obesity, quitting smoking, drinking less alcohol, and reasonable control of blood pressure, blood glucose, and blood lipids.
Drug therapy
Drug therapy mainly includes stabilization of atherosclerotic plaques and anti-platelet drugs. Commonly used in the clinic are statins and aspirin and/or clopidogrel. In addition, pharmacotherapy also includes medications to address risk factors such as hypertension and diabetes mellitus. Medication can only stabilize atherosclerotic plaque, minimize thrombosis, and slow the progression of atherosclerosis to reduce the incidence of cerebral ischemic events, but it does not remove the plaque or restore blood flow to the brain tissue.
Surgical treatment
Surgical treatment mainly refers to carotid endarterectomy (CEA). It is currently the only method that can achieve the removal of atherosclerotic plaque and the reconstruction of normal lumen and blood flow. By the 1980s, many centers in Europe and the United States began to conduct systematic research on CEA, a number of multi-center large sample randomized controlled studies show that CEA for severe carotid stenosis and symptomatic moderate carotid stenosis treatment effect is significantly better than drug therapy, now, North America can reach 170,000 per year CEA has become the first choice of treatment for carotid stenosis program. CEA has become the preferred treatment for carotid artery stenosis. It is the "gold standard" for the treatment of carotid artery stenosis in the carotid segment.
Interventional therapy
After the 1990s, with the advancement of equipment and devices, carotid stenting angioplasty (CAS) was gradually carried out and popularized, and has a tendency to replace CEA. Carotid Stenting Angioplasty (CAS) is based on endovascular interventional technique, which uses balloon or stent to dilate the stenosis of carotid artery in order to re-establish the carotid artery blood flow.
In 1998, the United Kingdom was the first country to design a comparative study of CEA versus CAS for symptomatic carotid artery stenosis, which was terminated by the Safety Board due to the immaturity of the CAS technology.
In 2001, the results of the CAVATAS study were published, and the results of the trial***, in which 253 cases of CEA versus 251 carotid stenosis cases were treated endovascularly, showed that the incidence of major prognostic events within 30 days of stenting was much lower than that of CEA. day incidence of major prognostic events was similar, cranial neuropathy was significantly more common in the surgical group, localized hematomas were less common in the endovascular group, and severe stenosis was more common in the endovascular group at 1 year, concluding that the effectiveness and safety of the two were similar and that endovascular treatment reduced minor complications.
Subsequently, from 2003 to 2010, the CARESS study, the SAPPHIRE study, the EVA-3S study, the SPACE study, the ICSS study, and the CREST study reported different results, in which the SAPPHIRE study, although concluding that there was no significant difference between the two in terms of efficacy and safety, concluded that the surgical high risk for the The SAPPHIRE study, although there is no significant difference in effectiveness and safety between the two, seems to be more suitable for CAS treatment in special populations at high risk for surgery; the EVA-3S study, the SPACE study, and the ICSS study are more inclined to CEA treatment; and the CREST study is the largest set of international multicenter, randomized, controlled clinical trials to date, with the participation of 108 research centers in the United States and 9 research centers in Canada, which was aimed at comparing the therapeutic roles of CEA with those of CAS in the management of carotid stenosis of extracranial segments. The mean follow-up time was 2.5 years, with no significant difference between the CAS and CEA groups (7.2% vs. 6.8%, P=0.51), and there was no significant difference between the CAS and CEA groups in the incidence of perioperative primary endpoint events. CEA were also not significantly different between the two groups (5.2% vs 4.5%, P=0.38), and further stratified statistics showed that there was no significant difference in perioperative mortality between the CAS and CEA groups (0.7% vs 0.3%, P=0.18), and that CAS was significantly higher than CEA in the incidence of perioperative stroke (4.1% vs 2.3%, P=0.01), but CAS was lower than CEA in perioperative myocardial infarction incidence (1.1% vs 2.3%, P=0.03), and other subgroup analyses also suggested that the senior population was more suitable for CEA treatment.
Based on these results from more than 20 years of foreign research, the US and European guidelines for stroke prevention and treatment now clearly identify CEA as the treatment of choice for carotid atherosclerotic stenosis and suggest that CAS can achieve similar or even better results in special populations.
Earlier this year, 14 professional societies in the United States jointly published "Guidelines for the Management of Extracranial Segmental Carotid and Vertebral Artery Disease: A Joint Guideline of Multiple Scientific Committees," which, while emphasizing the preferred choice of CEA, has been appropriately liberalized with regard to the indications for CAS, not only as a partial alternative to CEA, but also for asymptomatic carotid stenosis in patients with stenosis (angiographic stenosis of 60% or more, Doppler ultrasound of 70%). 70% by Doppler ultrasound), it is recommended that prophylactic CAS may be considered in highly selective cases; meanwhile, the perioperative safety of CEA versus CAS is re-emphasized, and the perioperative stroke or mortality rate must be less than 6%.
Carotid artery stenosis characteristic therapy
Physical plus Chinese medicine treatment - brain through the sparing Luo Ning embolism therapy
Brain through the sparing Luo Ning embolism therapy treatment system is in the Chinese medicine under the guidance of the basic theory of the combination of the development of modern science and technology, the integrated application of Chinese medicine theory, biomedical engineering, computer technology, Information and sensor technology, etc., and the development of intelligent, standardized diagnostic and treatment equipment with Chinese medicine characteristics.
I. Multidisciplinary positioning, synthesizing the essence of Chinese and Western therapies
Including molecular genetics, cellular pathology, nanopharmacology, biophysics, molecular immunology, medical psychology and other disciplines, according to the World Health Organization (WHO) norms for the diagnosis and treatment of cerebral diseases, on the basis of the international authority of cerebral thrombosis, cerebral infarction, cerebral blood supply insufficiency medical treatment standards, combined with the characteristics of traditional Chinese medicine to develop the "cerebral thrombus, cerebral infarction, cerebral supply insufficiency medical treatment. On the basis of the diagnostic and treatment standards of international authoritative medical and rehabilitation institutions for cerebral thrombosis and insufficient cerebral blood supply, the company combines the characteristics of Chinese traditional medicine and develops the "Cerebral Thrombosis Therapy".
Second, multi-dimensional customized, "one-to-one" targeted treatment
It is the first cerebral thrombosis, cerebral infarction, cerebral hypoperfusion treatment system that puts forward multi-dimensional and three-dimensional treatments, and develops a personalized comprehensive treatment plan for each patient according to the guidelines of "one-to-one" targeted treatment, and then develops a comprehensive treatment plan for each patient. In accordance with the "one-to-one" targeted treatment guidelines for each patient to develop a personalized comprehensive treatment plan, the use of "cloud electric motor brain function cycle therapy instrument" target positioning, combined with the patient's own physical strengths and weaknesses, to make the most effective, safe and fast treatment system.
Three, a comprehensive assessment of the condition, to eliminate drug damage to the organism
The first introduction of the full digital cerebral thrombosis, cerebral infarction, cerebral blood supply insufficiency foci pinpointing system, completely eliminating conventional surgical treatment, drug treatment of cerebral thrombosis, cerebral infarction, cerebral blood supply insufficiency for the patient's harm, does not damage the liver, kidneys, etc., and does not leave the patient's body aftereffects.
Fourth, the treatment time is short, the rehabilitation effect is good
A kind of central nervous system regeneration therapy can repair the damaged brain cells of the patients in a short time, restore the blood supply and oxygenation of the brain foci, activate the damaged "dormant" brain tissue cells, and promote the newborn of brain cells. After one week of treatment, 97% of the patients will have a significant improvement in brain function, with the later rehabilitation training, proprietary Chinese medicine conditioning, the rehabilitation effect is obvious, completely solved the cerebral thrombosis, cerebral infarction, cerebral blood supply insufficiency can not be cured of the historical problems.
Diagnosis
1. Men older than 60 years of age, with a long history of smoking, obesity, hypertension, diabetes and high blood lipids and other risk factors for cardiovascular and cerebrovascular diseases.
2. Carotid vascular murmur found during physical examination.
3. Diagnosis can be made by comprehensive analysis of the results of non-invasive auxiliary examinations.
Common causes of carotid artery stenosis
(1)Atherosclerosis
The most common cause of carotid artery stenosis
The most common cause of carotid artery stenosis is the common carotid artery bifurcation, internal carotid artery in the carotid and cavernous sinus, the basilar artery, and the middle cerebral artery (MCA). Lesions in the bifurcation of the common carotid artery often involve both the distal end of the common carotid artery (CCA) and the proximal end of the internal carotid artery, and the lesions are mainly extended along the posterior wall of the artery, suggesting that localized cerebral blood flow impinges on the intima-media of the vessel.
(2)Fibromuscular dysplasia of the carotid arteries
It is a non-inflammatory vascular disease characterized by stenosis of the carotid and renal arteries.
Prevalent in Caucasian women aged 20 to 50 years. It often involves both carotid and vertebral arteries, but the bifurcation of the common carotid artery is often not involved (different from atherosclerosis). 20% to 40% of patients have intracranial aneurysms.
(3)Carotid artery intimal dissection
There are two kinds of trauma and spontaneous. In traumatic cases, the carotid artery is impinged on the transverse process of the second cervical vertebra due to hyperextension of the neck by rotational violence. In spontaneous cases, it is often associated with atherosclerosis and fibromuscular developmental abnormalities. Angiographically, the disease is characterized by a bird's beak stenosis or obstruction of the carotid artery distal to the bifurcation of the common carotid artery, which may extend to the base of the skull, sometimes accompanied by an aneurysm.
Auxiliary examination
Doppler ultrasonography
Doppler-ultrasonography is a non-invasive carotid artery examination that organically combines Doppler flowmetry and real-time imaging of B-ultrasound, which is currently the preferred non-invasive carotid artery examination, and is characterized by simplicity, safety and low cost. It not only displays the anatomical image of the carotid artery and carries out morphological examination of the plaque, such as distinguishing between intra-plaque hemorrhage and plaque ulceration, but also displays the arterial blood flow, flow velocity, direction of blood flow and intra-arterial thrombus. The accuracy of diagnosing the degree of carotid artery stenosis is more than 95%, and Doppler-ultrasound has been widely used in the screening and follow-up of carotid artery stenosis lesions. The shortcomings of ultrasonography include:
①It is not possible to examine intracranial internal carotid arteries;
②The results of the examination are susceptible to the skill level of the operator.
Magnetic resonance angiography
Magnetic resonance angiography (MRA) is a noninvasive vascular imaging technique that clearly shows the three-dimensional morphology and structure of the carotid arteries and their branches, and is capable of reconstructing the image of intracranial arteries. The carotid vessels, with their linear contours, are particularly well suited for MRA, which can accurately visualize thrombotic plaques, the presence or absence of entrapment aneurysms, and intracranial arteries, which can be extremely helpful in diagnosis and protocol determination.
The prominent disadvantage of MRA is that slow or complex blood flow often results in signal loss and exaggerated stenosis. It also has limitations in visualizing sclerotic plaques. MRA is contraindicated in patients with metal traps (e.g., metal stents, pacemakers, or metal prostheses).
CT angiography
CT angiography (CTA) is a non-invasive angiographic technique based on spiral CT. CTA is a non-invasive angiographic technique developed on the basis of spiral CT. The method is to inject a contrast agent through a blood vessel, perform a volumetric scan when the concentration of the contrast agent in the circulating blood or in the target blood vessel reaches its peak, and then process it to obtain a digitized three-dimensional image. The carotid arteries in the extracranial segment are suitable for CTA, mainly because the carotid arteries are oriented perpendicular to the CT section, thus avoiding the relative lack of resolution of horizontally oriented vessels in spiral CT scans.The advantage of CTA is the ability to directly visualize calcified plaque.
Currently, three-dimensional vascular reconstruction generally adopts surface shaded display (SSD) and maximum intensityprojection (MIP), and MIP reconstructed images can be similar to angiographic images and can show calcification and wall thrombus, but the three-dimensional spatial relationship is not as good as that of SDD. MIP reconstruction images can be similar to angiographic images, and can show calcification and wall thrombus, but the three-dimensional spatial relationship is not as good as SDD, but SDD can not directly show the density difference.
Digital subtraction angiography
At present, although non-invasive imaging methods have been more and more widely used in the diagnosis of carotid arterial lesions, there are definite advantages and disadvantages of each method. High-resolution MRA, CTA, and Doppler-ultrasound imaging are valuable for initial diagnosis and follow-up. Although angiography is no longer used for screening, initial diagnosis, and follow-up, digital subtraction angiography (DSA) is still the "gold standard" for diagnosing carotid stenosis in terms of accurately evaluating the lesion and determining treatment options.
The DSA examination of carotid artery stenosis should include aortic arch angiography, selective angiography of bilateral common carotid arteries, selective angiography of intracranial carotid arteries, selective angiography of bilateral vertebral arteries, and selective angiography of basilar arteries.
The DSA examination can provide a detailed understanding of the location, scope and extent of the lesion and the formation of collateral branches, and can help to determine the nature of the lesion, such as ulcerations, calcified lesions, and thrombus formation; and to understand the nature of the coexisting vascular lesions, such as aneurysms. Coexisting vascular lesions such as aneurysms and vascular malformations. Arteriography can provide the most valuable imaging basis for surgical and interventional therapy.
Arteriography is a traumatic and expensive examination, and the literature reports a complication rate of 0.3% to 7%. The major complications are cerebral vasospasm, dislodgement of plaque causing stroke, cerebral embolism, and contrast allergy. Renal function impairment, vascular injury and hematoma at the puncture site, pseudoaneurysm and so on.
Methods for determining carotid artery stenosis
Despite the increasing role of ultrasound, computerized tomography (CT), magnetic resonance imaging (MRI) and other noninvasive tests in the diagnosis of carotid artery stenosis, the role of arteriography is still the best way to diagnose carotid artery stenosis. At present, arteriography is still the "gold standard" for the diagnosis of carotid artery stenosis. The degree of carotid stenosis is determined by arteriography. Different research departments have adopted different measurement methods, and there are two commonly used measurement methods in the international arena, namely, the North American Symptomatic Carotid Endarterectomy Trial Collaborators (NASCET) standard and the European Carotid Surgery Trial Collaborators (ECTC) standard. Surgery Trial collaborators Group (ECST) criteria.
After reading the article, I would like to ask for a comment.