Bai Jun Qu Lefeng
In recent years, with the improvement of people's health awareness, more and more attention to physical examination, and media reports, the new term "carotid plaque" has repeatedly appeared in the public eye, and is often inseparable from "stroke", so that there are many people talking about plaque discoloration.
It is generally believed that arterial plaque is one of the manifestations of natural aging of the human body, just like white hair when older, but in recent years, the increasingly younger and larger people with carotid plaque have made people have to face this health problem. According to incomplete statistics, there are more than 1 million people with carotid plaque in China, and the health risks buried by this cannot be underestimated. What exactly is carotid plaque, what are the hazards, and how to deal with it?
With carotid plaque, it must fall off?
Just as the water pipe rusts for a long time, the blood vessels of the human body, especially the arteries, will also rust over time, and we can call the "rust spots" of the arteries "arterial plaque". Arterial plaque is a manifestation of atherosclerosis and a sign of the aging of blood vessels in the body. The arterial system of the human body is a whole and extends in all directions, so plaque can grow in various parts of the arterial system throughout the body, and it is carotid plaque that grows in the carotid artery. Therefore, the vast majority of elderly people will be accompanied by carotid plaque.
In this case, is carotid plaque safe and harmless? The answer is no!
We often encounter patients with carotid plaque in the outpatient clinic, and they are often very nervous, thinking that once they have carotid plaque, they will shed embolism and lead to cerebral infarction. Is the truth so terrible? With carotid plaque, it must fall off? This is actually a matter of score.
Under normal circumstances, people over 60 years old, healthy people, no hypertension, hyperlipidemia, diabetes and other metabolic diseases, a few millimeters of carotid plaque, will not cause obvious harm to the human body.
So, what kind of carotid plaque needs to be raised alarm? These three groups of people should pay attention to:
The first is patients with "three highs". Hyperlipidemia, hyperglycemia, and hypertension themselves are important causes of arterial plaque, especially in patients with hyperlipidemia, the main component of arterial plaque is lipid deposition.
The second is those with poor living and eating habits. For example, lack of exercise, obesity, preference for high-oil and fatty foods, smoking, etc., these bad habits will accelerate the growth of carotid plaque.
The third is young patients with carotid plaque. We often meet patients with carotid plaque around the age of 30 to 40, who are regarded as a younger group of "arteriosclerosis", often accompanied by genetic factors of arterial disease, and their carotid plaque may develop faster than ordinary people, which requires additional attention.
In real life, these three situations often exist in combination, and a variety of high-risk factors affect each other.
What are the adverse consequences of carotid plaque?
"Can the rust of the water pipe be cleaned, and the carotid plaque can be removed?" Many patients present good questions for clinicians and medical researchers. Medical scientists have been trying to get rid of plaque. Unfortunately, most of the current carotid plaque can not be effectively removed, and clinical studies have reported that only the early microscopic plaque can be reversed by strong drug lipid-lowering therapy.
Since carotid plaque cannot be removed, can it only be allowed to develop? Of course not. People of any age, once carotid plaque is detected, they must attach great importance to it, actively screen for high-risk factors and underlying diseases, and pay attention to diet and living habits.
When carotid plaque continues to grow large enough to protrude significantly into the lumen of the carotid artery, it can lead to carotid artery stenosis, and severe blockage of the carotid artery leading to blood supply to the brain.
In addition, large carotid plaques rupture and bleed, and exfoliates embolize the intracranial artery along the bloodstream, resulting in acute ischemia of distal brain tissue, called ischemic stroke. This is the most serious consequence of carotid plaque. Carotid artery stenosis associated with carotid plaque accounts for 30%-50% of the cause of ischemic stroke, so carotid plaque is undoubtedly called the invisible killer of the brain!
What should I do if I have carotid plaque?
Since carotid plaque is very harmful, is it necessary to remove it surgically as long as there is carotid plaque? This is one of the most frequently asked questions. In fact, although carotid plaque is harmful, there is no need to be overly nervous. In terms of handling, it is also divided into three situations.
First, for elderly patients with carotid plaque, they are often accompanied by hypertension, hyperlipidemia, diabetes, etc., and many are also combined with other cardiovascular and cerebrovascular diseases. For these patients, we recommend increased surveillance, strict control of the underlying condition, and pharmacotherapy.
The second is young patients. The time of carotid plaque in such patients is advanced, so we recommend six months to one year of follow-up observation, strict diet control, strengthen exercise, quit smoking and limit alcohol, and try to control stable plaque through non-drug means. However, for metabolic diseases such as "three highs", active drug control is still required.
The third is relatively healthy carotid plaque. They have no bad habits, eat a healthy diet, and have no comorbidities. In this population, we recommend follow-up observation first, and if there is no significant change in carotid plaque found by prolonged monitoring, no special intervention is required. Early medical therapy is also recommended if plaque growth is found, despite the absence of underlying disease.
A cost-effective means of carotid plaque monitoring is carotid ultrasound, and classical drug therapy is preferred with antiplatelet drugs such as aspirin, and lipid-controlling drugs such as statins.
If carotid plaque is still not effectively controlled by various means, or even if it is found to be carotid artery stenosis, and the indications for surgery are met, surgical treatment is required. When carotid plaque progresses and more than 70% of the carotid artery is narrowed, surgery is required even if there are no symptoms, such as cerebral infarction. Or although more than 70% carotid artery stenosis has not been reached, plaque shedding and cerebral infarction have occurred, and aggressive surgical treatment is required to remove or stabilize the plaque.
Finally, it is important to stress repeatedly that carotid plaque is not terrible. Regular regular examination and follow-up, so that arterial plaque can be dynamically supervised, effectively managed, timely and appropriate intervention, so that these "irregular time bombs" become "duds", which can achieve arterial plaque without the human body getting sick.
(The authors are all vascular surgeons of the Second Affiliated Hospital of the Naval Military Medical University, with Bai Jun as the deputy chief physician and Qu Lefeng as the chief physician)