Introduction: With the continuous advancement of modern medical technology, carotid artery ultrasound examination has gradually become a routine item of health examination. As a result, more and more people are finding that they have the problem of "carotid plaque" during physical examinations.
Faced with this outcome, many people may feel nervous and worried, fearing that it will increase the risk of stroke, while also being reluctant to undergo medications** or interventional procedures** for a long time.
However, in fact, not all carotid plaques are equally dangerous, and some plaques have a relatively low risk, and for this part of the plaque, we can temporarily disregard medications**, so when we find carotid plaque in a physical examination, the first thing we need to understand is the level of risk.
So, how can you tell if carotid plaque is dangerous? We can get a rough idea by the descriptions in the ultrasound report, which can give us some clues that will help us understand the level of risk for plaque. 
The Lancet, a global authoritative medical journal, released a shocking study, which spanned 21 countries and regions, and in-depth the grim status of "carotid atherosclerosis prevalence", data shows that in 2020, the number of carotid atherosclerosis cases has soared to a staggering 2 billion worldwide.
Sadly, our country has taken a significant share of this huge number, reaching 2700 million, and what is even more shocking is that 200 million of them suffer from carotid plaque, which is a staggering number.
The report shows that clinically, about 50% of 75% of ischemic strokes are closely related to carotid artery lesions, which not only occur frequently, but also directly threaten the lives of patients once the condition is severe.
In the face of this dire situation, we can't help but ask: why is carotid plaque so common and dangerous, but people still don't know enough about it?
The high incidence of carotid plaque and its potential danger are undoubtedly a great challenge facing contemporary medicine and society, but we are deeply concerned by the public's neglect and lack of understanding of this health risk.
It's time to be vigilant and educate more people about the potential health threat of carotid plaque so that they can take proactive prevention and intervention.
The occurrence of plaque, silently, quietly indicates the arrival of arteriosclerosis, and in the early stage of the lesion, the patient may still be able to live as usual without feeling the obvious abnormality.
But over time, the plaque grows like a lurking beast, and once it exceeds 50% of the lumen of the blood vessels, the flow of blood is blocked. At this time, the risk of plaque detachment increases significantly, and once a blood clot develops, the consequences can be devastating.
Imagine the crumbs of plaque drifting around the bloodstream, and if they drift into the brain, the consequences can be severe, they can block the small blood vessels in the brain, causing some of the brain tissue to be ischemic or necrosis, making the patient feel dizzy, blurry vision, and even impairing mobility.
More seriously, if the blood vessels blocked by debris are thicker, the effect on blood supply to the brain will be more significant. In this case, the patient may be at risk of cerebral infarction or stroke. Once the disease occurs, patients may experience symptoms such as dizziness, syncope, hemiplegia, and abnormalities on one side of the body, which may even be life-threatening in severe cases.
And the formation of these plaques is closely related to some of our bad habits:
Smoking
Cigarette smoking is an important risk factor for carotid plaque formation, and studies have shown that smokers have a significantly higher prevalence of plaque than nonsmokers.
The nicotine in cigarettes promotes the development of atherosclerosis, lowering the high-density lipoprotein that protects the arteries from atherosclerosis while increasing blood pressure.
Heavy alcohol consumption
Heavy alcohol consumption not only leads to reduced cerebral blood flow, but may also damage the liver and affect lipid metabolism, thereby accelerating the formation of carotid plaque.
Unhealthy eating habits
A diet high in salt, sugar, and oil not only causes obesity, but also increases the risk of high blood pressure. At the same time, this diet can lead to high blood sugar and insulin levels, allowing more oil to be deposited on the walls of blood vessels, accelerating the growth of carotid plaque.
Lack of exercise
Long-term sedentary life will affect blood circulation, lead to the accumulation of garbage in blood vessels, and easily form atherosclerotic plaques.
The location and size of the plaques
When the carotid artery stenosis reaches or exceeds 50%, it means that the plaque has had a significant impact on blood flow, and the risk in this case should not be ignored.
Similarly, when the carotid intima-media thickness (IMT) exceeds 15 mm, it is also a warning sign that the plaque may have progressed to a more severe stage.
In addition to the quantitative indicators mentioned above, the morphology and internal structure of the plaque are also important factors in assessing risk. Plaques with irregular morphology may be more likely to slough off, leading to embolic events; Plaques with an unsmooth surface may be more likely to cause platelet aggregation and clotting; Unequal internal echogenicity may indicate the presence of an unstable component within the plaque, increasing the risk of rupture and vascular events.
The risk of plaque increases significantly when two or more "high-risk features" are present, and these features work together to increase the chance of plaque rupture, detachment, and vascular events.
Carotid artery intimama (IMT) value
Secondly, we must pay enough attention to the IMT value in the report, which is the carotid intima medial thickness, which is a key indicator of the health of the carotid artery, and under normal circumstances, the IMT value should be kept at 0Below 9 mm, this is an essential criterion for a healthy carotid artery.
However, when IMT values fall outside this normal range, it acts as a silent wake-up call, alerting us that the carotid lining is thickening, which may not only indicate an underlying health problem, but also increase the risk of carotid plaque formation.
Carotid plaque is a serious health problem that can lead to narrowing of the carotid arteries, affecting blood in the brain**, and may even trigger serious conditions such as stroke. It is important to note that there is a clear positive correlation between IMT values and potential health risks.
In other words, the higher the IMT value, the more severe the carotid intima, and the greater the possible health risk, which is not untraceable, but can be warned and intervened in advance through the monitoring and evaluation of the IMT value.
The degree of carotid artery stenosis
Carotid artery stenosis is often closely related to hemodynamics, and in general, when the carotid artery stenosis does not exceed 70%, it does not cause significant hemodynamic abnormalities in most cases. This means that the brain's blood** will not be significantly disturbed under normal physiological conditions. However, we should not take this lightly.
In special situations, such as when a person's blood pressure is too low or if there is a rapid change in their position, such as a rapid change from a supine position to a standing or sitting position, even a small carotid artery may cause a transient ischemic attack.
This transient cerebral ischemia, although it may be short-lived, can also have a significant impact on the patient's daily life and, in some cases, may even lead to more serious health problems.
Therefore, for carotid artery stenosis, we not only need to pay attention to the degree of stenosis, but also closely observe the patient's symptoms and signs, and whether the stenosis has a tendency to develop further. Only in this way can we ensure that effective measures are taken to intervene and ** before the carotid artery stenosis problem causes serious consequences.
Visual impairment
Carotid plaque may affect the blood flow in the eye**, causing symptoms such as blurred vision, visual field defects, or double vision, and if these symptoms occur, you should see your doctor promptly.
Dizziness and vertigo
Carotid plaque can cause narrowing of blood vessels and affect blood flow to the brain**, triggering symptoms such as dizziness and vertigo, which may worsen with activity and resolve with rest.
Facial numbness and crooked mouth and eyes
Carotid plaque may affect the blood flow to the facial nerve**, causing facial numbness, crooked mouth and eyes, and other symptoms, which may be due to nerve damage and should be checked by a doctor promptly.
Drugs play a pivotal role as the dominant force in carotid plaques, but their use is not static and requires fine-tuning for different conditions. For patients with large plaques and more than 50% of stenosis blockages, the combination of statin and aspirin becomes a necessary option.
Statins can effectively lower LDL cholesterol and inhibit the formation and development of plaque, while aspirin can fight platelet aggregation and prevent thrombosis, and the two complement each other to maintain vascular health.
For patients with small plaques and no more than 50% stenosis and blockage, if they suffer from serious diseases such as coronary heart disease and cerebral infarction, a combination of statin and aspirin** is also required to prevent the potential risk of cardiovascular and cerebrovascular diseases.
In addition, the use of statins is essential in patients over the age of 40 with diabetes, as diabetes is a high risk factor for cardiovascular disease and statins can significantly reduce the risk of cardiovascular events.
When the plaque is small, the patient has no coronary heart disease, cerebral infarction and other diseases, and no smoking habits, but the LDL cholesterol is more than 4At 1 mmol, only a statin is required.
And when this number exceeds 4At 9 mmol, ezetimibe should be added to statins to further reduce cholesterol levels and reduce plaque formation and development.
However, it is important to note that drugs** are not preferred in patients with less than 50% vascular stenosis and no other overt symptoms.
On the contrary, interventions in daily lifestyles, such as reasonable diet, moderate exercise, smoking cessation and alcohol restriction, can often achieve good control results, and these daily interventions are not only simple and easy to implement, but also low cost, which is an economical and effective option for the majority of patients.
Therefore, in the process of carotid plaque, doctors need to formulate a personalized plan according to the specific condition of the patient, not only to make full use of the advantages of drugs, but also to pay attention to lifestyle adjustments to achieve the best results.
Surgery**
Some severe carotid plaques may require surgery**, including carotid endarterectomy and carotid artery stenting, which can effectively remove or shrink the plaque and restore patency to the carotid arteries, thereby improving blood flow to the brain**.
Lifestyle changes
It is recommended to maintain a healthy diet, avoid foods high in fat, sugar and salt, and increase the intake of vegetables, fruits and whole grains.
At the same time, maintaining a moderate amount of exercise, controlling weight, quitting smoking and limiting alcohol can all help reduce the risk of carotid plaque.
Control risk factors
Hypertension, hyperlipidemia, diabetes mellitus, etc. are all risk factors for carotid plaque formation, so active control of these risk factors is also an important measure to improve carotid plaque. Under the guidance of doctors, rational use of antihypertensive, hypoglycemic, lipid-lowering and other drugs to control the relevant indicators within the ideal range.
Aspirin, as an antiplatelet drug, can effectively prevent thrombosis and reduce the risk of cardiovascular events; Statins, on the other hand, slow the progression of carotid plaque by regulating blood lipids, especially LDL cholesterol.
However, medication use is not set in stone, and whether it should be taken consistently depends on the patient's specific situation and the doctor's advice.
On the one hand, it may be necessary to continue taking both drugs for some patients, especially those with pre-existing cardiovascular disease or high-risk factors, for whom discontinuation may increase the risk of cardiovascular events and be detrimental to health.
On the other hand, we also need to note that aspirin and statins that may come with the drug, although beneficial to most people, may also cause some adverse reactions, such as gastrointestinal discomfort, muscle pain, etc.
Therefore, when deciding whether to continue taking these medications, doctors need to consider the patient's overall health, the efficacy of the drugs, and the potential risks to make an individualized decision.