What Causes Carotid Artery Pain?

Carotid plaque is a manifestation of carotid atherosclerosis, which occurs at the common carotid bifurcation, and is currently considered to be closely related to the occurrence of ischemic stroke in the elderly. The mechanism of ischemic stroke may be: plaque enlargement causes carotid artery stenosis, intracranial hypoperfusion and plaque detachment to form emboli, resulting in intracranial artery embolism. Clinically, carotid plaque is evaluated by carotid stenosis and morphological measurement to determine its hazard.

Basic Information

Visiting department: Vascular surgery
Common locations: Carotid artery

Common symptoms: Dizziness, headache, syncope, transient ischemic attack, ischemic stroke
Contagious: no

Causes of carotid plaque

Carotid plaque formation is the same as atherosclerosis and is affected by many factors. Among them, age> 60 years, male, long-term smoking history, history of hypertension, history of diabetes and hyperlipidemia were risk factors for carotid plaque formation.

Clinical manifestations of carotid plaque

According to whether there are related symptoms of cerebral ischemia, it is divided into two categories: symptomatic and asymptomatic (same as carotid stenosis):

Symptomatic

(1) Transient ischemic attack (TIA) can be manifested as transient unilateral limb sensation, dyskinesia, monocular blindness or aphasia, etc., usually lasting only a few minutes, and fully recovered within 24 hours after the onset. After the attack, there were no clear positive signs on examination and no focal lesions on imaging examination;

(2) Ischemic stroke The common clinical symptoms include limb sensation and / or dyskinesia on one side, and aphasia. Coma may occur in severe cases. On examination, there may be signs of the corresponding nervous system localization, and imaging examination may show focal lesions.

Asymptomatic

Many patients with carotid sclerosis have no neurological symptoms or only non-specific manifestations, such as dizziness, headache, and syncope.

Carotid plaque

Doppler ultrasound

The currently preferred noninvasive carotid artery examination method is widely used in the screening and follow-up of carotid atherosclerotic lesions. Not only can it show the location and size of plaques, the location and severity of luminal stenosis, but also hemodynamic measurements and morphological evaluation of plaques. Color Doppler ultrasound determines the presence of atherosclerotic plaques by measuring the carotid intima-media thickness (IMT). Normal IMT should be less than 1.0mm, IMT is thickened from 1.0 to 1.2mm, and plaque formation is greater than 1.2mm. According to the morphological and echo characteristics under ultrasound, plaques can be divided into low-echo lipid soft plaques; medium echo fibrous flat plaques rich in collagen; calcified hard plaques with strong echo and acoustic shadow; Ulcerative mixed plaques with varying echo strength. Among them, soft plaques, flat plaques, and mixed plaques are unstable plaques and are one of the important causes of ischemic stroke.

2. Transcranial Doppler Ultrasound (TCD)

Another non-invasive examination method can show the stenosis location, degree, blood flow velocity, blood flow direction, and whether collateral circulation is open in the internal and external cranial artery. It is often used in conjunction with Doppler ultrasound to diagnose and treat carotid stenosis. Post evaluation.

3.CT angiography (CTA)

CTA is more accurate in judging carotid stenosis than Doppler ultrasound, but it shows poor morphology of plaques. It is currently widely used in the diagnosis of stenosis and can be used as an important basis for preoperative diagnosis and treatment planning.

4. Nuclear Magnetic Angiography (MRA)

It can clearly show the three-dimensional morphology and structure of the carotid artery and its branches, and reconstruct the intracranial arterial image. It is highly sensitive to the judgment of the more severe stenosis, but the price is relatively high. Pacemakers or metal prostheses, etc.) are not allowed to undergo this test.

5. Digital Subtraction Angiography (DSA)

DSA is the gold standard for diagnosing carotid stenosis. It can evaluate the location, extent, extent, and collateral formation of the lesion in detail. However, it is rarely used clinically because it is invasive, expensive, and high-risk.

Carotid plaque treatment

Treatment of carotid sclerosis includes lifestyle changes, medications, and surgery.

Change in lifestyle

Including quitting smoking, strengthening exercise, controlling weight, low salt and low fat diet, etc.

2. Drug treatment

(1) Control blood pressure, blood sugar and blood lipid;

(2) Antiplatelet therapy: Prophylactic use of antiplatelet drugs can significantly reduce the incidence of ischemic cerebrovascular disease. Aspirin or clopidogrel can be taken orally daily;

(3) Intensive lipid-lowering treatment: Multiple clinical studies have confirmed that statins can stabilize plaque, significantly reduce the incidence and mortality of cardio-cerebral vascular events, and can be based on the patient's LDL-C level and whether it is combined with other ischemic brain Stroke risk factors, use of statins as appropriate to control blood lipids. Monitor the changes of liver enzymes and muscle enzymes regularly during taking.

3. Surgical treatment

The purpose of surgical treatment is to prevent the occurrence of ischemic stroke. Clinically, doctors will decide whether to perform surgery and what kind of surgery to use according to the degree of carotid plaques leading to vascular stenosis and plaque stability, combined with the patient's symptoms and basic conditions.

(1) Carotid endarterectomy (CEA): Carotid arterial endometrium and sclerotic plaques that are thickened by surgery are mostly performed under general anesthesia, and patients are required to have no serious heart, lung or other systemic diseases;

(2) Carotid stent implantation (CAS): For minimally invasive surgery, a stent is placed at the diseased position to open the narrow vessel wall to restore smooth blood flow to the disease, which can be completed under local anesthesia, which is suitable for combining severe foundations. Patients whose disease cannot tolerate general anesthesia. Aspirin and clopidogrel should be given dual antiplatelet therapy 3 to 5 days before the operation. The forward patency rate of CAS is currently considered to be the same as that of CEA.

Carotid plaque prevention

The prevention of carotid sclerosis is mainly to develop a good lifestyle and actively control risk factors. Such as a reasonable diet, limit salt and fat intake; strengthen exercise to control weight; control blood pressure, blood sugar, blood lipids and so on.