Disease is the main factor endangering human health. Many people don't know much about the common sense of diseases in daily life. If you want to treat every disease, you must first know more about the cause! Nowadays, many people suffer from carotid stenosis. Do you know what the symptoms of carotid stenosis are? What should I do if I have carotid stenosis? Let's take a look at the details of Bian Xiao's treatment of carotid stenosis!
catalogue
1, Overview of Carotid Artery Stenosis 2. Clinical manifestations of Carotid Artery Stenosis
3. The characteristic treatment of carotid stenosis. Common causes of carotid stenosis
5. Symptoms of carotid stenosis. Harm of carotid artery stenosis
7. Carotid stenosis needs to be examined. Surgical indications of carotid artery stenosis
General situation of carotid artery stenosis
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 supply vessels of the brain. According to literature reports, even if patients with severe carotid artery stenosis are treated with effective drugs, the incidence of cerebral ischemic events is as high as 26% or more within two years. More than 60% of cerebral infarction is caused by carotid stenosis, and severe cerebral infarction can lead to disability or even death. Therefore, carotid artery stenosis has become one of the "number one" factors that endanger people's health in today's society.
The cause of the disease
Carotid artery stenosis can be caused by many reasons, and the characteristics of carotid artery stenosis caused by different reasons are different.
atherosclerosis
Atherosclerosis is the most common cause of carotid stenosis in middle-aged and elderly patients. Patients are often accompanied by hypertension, diabetes, hyperlipidemia, obesity, smoking and other risk factors that easily lead to cardiovascular and cerebrovascular damage. Atherosclerosis is due to the accumulation of lipid substances on the blood vessel wall, and the macrophages in the blood vessel wall phagocytose lipid substances to form lipid pools, accompanied by the formation of fiber caps on the surface of lipid pools. Lipid core and fibrous cap constitute the main components of atherosclerotic plaque on arterial wall. The increase of plaque gradually narrows the lumen, or the plaque is unstable and ruptured, and the lipid components in the plaque are exposed to the vascular lumen, leading to thrombosis and thrombus shedding. Will lead to the occurrence of cerebral ischemia events. Carotid artery stenosis caused by atherosclerosis is often located at the end of common carotid artery. The initial segment, siphon segment and terminal segment of internal carotid artery are divided into anterior cerebral artery and middle cerebral artery.
Carotid dissection
Carotid artery consists of intima, smooth muscle layer and adventitia layer. Under normal circumstances, the layers are interconnected into a unified whole, and blood flows in the cavity surrounded by the blood vessel wall. The so-called arterial dissection, as its name implies, is the separation between layers of blood vessel wall due to various reasons. According to the survey based on American and French communities, the incidence of carotid dissection is 65438+2.5-3/ 100000. In young patients under the age of 45, the stroke caused by carotid dissection can reach 25%.
Vascular diseases related to development, inflammation or autoimmunity
Other diseases, related to development, vascular inflammation and autoimmunity, can also lead to carotid stenosis, but the proportion is very small. Such as Takayasu's arteritis, fibromuscular dysplasia and moyamoya disease. In this part of patients, young patients account for a large proportion.
Clinical manifestations of carotid artery stenosis
Some patients with mild and moderate carotid stenosis may have no clinical symptoms. Clinically, the symptoms related to stenosis are called "symptomatic carotid stenosis".
The clinical manifestations of symptomatic carotid stenosis are mainly related to cerebral ischemia caused by vascular stenosis. According to the characteristics of onset time, it can be divided into transient ischemic attack and stroke. The main difference between them lies in whether the ischemic symptoms of patients can be completely relieved within 24 hours. Transient ischemic attack can be completely relieved, but stroke can not be completely relieved.
Ischemic symptoms caused by carotid artery stenosis mainly include dizziness, memory loss, disorientation of consciousness, blackening of the lateral and/or limbs, numbness and/or weakness, crooked tongue base, unfavorable speech, and inability to understand what others are saying.
Diagnosis and differential diagnosis
diagnose
The diagnosis of carotid artery stenosis is mainly based on the patient's clinical symptoms, physical examination and imaging examination. At present, the main imaging examination methods used in clinic mainly include morphological examination of blood vessels and examination of brain tissue. Imaging study of plaque properties and hemorheology is the future research direction.
Angiographic examination method
At present, the main vascular imaging methods for carotid artery are carotid ultrasound, transcranial color Doppler, CT angiography (CTA) and digital subtraction angiography (DSA). Among them, DSA is the "gold standard" of examination.
Brain tissue imaging examination
Ischemic changes of brain tissue caused by carotid artery stenosis are mainly examined by computed tomography (CT), magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI).
In addition, at present, there are clinical methods to check the nature of plaque based on nuclear magnetic resonance, mainly referring to multi-sequence nuclear magnetic resonance imaging, which uses the sensitivity of different scanning sequences of nuclear magnetic resonance to different tissues to detect the characteristics of the main components of plaque. But it has not been popularized in clinic.
differential diagnosis
The differential diagnosis of carotid artery stenosis mainly includes the differentiation of symptoms and location. Symptoms are mainly related to other brain diseases such as intracranial space occupying, seizures and other cerebrovascular diseases. The identification of location mainly refers to the need to judge whether carotid artery stenosis is the "responsible blood vessel" that leads to cerebral ischemia when it is combined with other vascular stenosis diseases.
treat cordially
The treatment of carotid stenosis mainly includes risk factor control, drug therapy, surgical treatment and interventional therapy.
Control of risk factors
Atherosclerotic carotid stenosis is usually a part of systemic vascular disease. Therefore, controlling the risk factors that can lead to vascular atherosclerosis is the basis of treating carotid artery stenosis. It mainly includes: proper exercise, weight control, avoiding obesity, quitting smoking, drinking less, and reasonably controlling blood pressure, blood sugar and blood lipid.
medicine
Drug therapy mainly includes stabilizing atherosclerotic plaque and antiplatelet drugs. Statins, aspirin and/or clopidogrel are commonly used in clinic. In addition, drug therapy also includes drug therapy for risk factors such as hypertension and diabetes. Drug therapy can only stabilize atherosclerotic plaque, minimize thrombosis, slow down the progress of atherosclerosis, and thus reduce the occurrence of cerebral ischemia events, but it can not fundamentally remove plaque or restore blood flow to brain tissue.
Surgical therapy
Surgical treatment mainly refers to carotid endarterectomy (CEA). This is the only way to remove atherosclerotic plaque and rebuild normal lumen and blood flow. In 1980s, many centers in Europe and America began to study CEA systematically. Many multi-center and large-sample randomized controlled studies show that CEA is obviously superior to drug therapy for severe carotid artery stenosis and symptomatic moderate carotid artery stenosis. At present, CEA in North America can reach 654.38+0.7 million per year, making it the first choice to treat carotid stenosis. It is the "gold standard" for the treatment of cervical carotid stenosis.
Interventional therapy
After 1990s, with the development of equipment and instruments, carotid stenting (CAS) has been gradually developed and popularized, and has a tendency to replace CEA. Carotid stent is mainly based on intravascular intervention technology, which uses balloon or stent to dilate carotid stenosis, so as to achieve the purpose of reconstructing carotid blood flow.
From 65438 to 0998, Britain took the lead in designing and developing a comparative study of CEA and CAS for symptomatic carotid stenosis, but CAS technology was immature and was terminated by the safety committee. 200 1, Kavatas published his own research results. During the trial, 253 patients with CEA and 25/kloc-0 patients with carotid artery stenosis were treated by intravascular therapy. The results showed that the incidence of major prognostic events was similar within 30 days. Cranial neuropathy was significantly more in the operation group, local hematoma was less than that in the endovascular treatment group, and severe stenosis was more common after 1 year.
Later, from 2003 to 20 10, CARESS study, SAPPHIRE study, EVA-3S study, SPACE study, ICSS study and CREST study all reported different results. Among them, SAPPHIRE study thought that there was no significant difference in their effectiveness and safety, but it seems that CAS is more suitable for special people with high surgical risk. EVA-3S research, space research and ICSS research are more inclined to CEA treatment; The CREST study is the largest international multi-center randomized controlled clinical trial so far. There are 65,438+008 research centers in the United States and 9 research centers in Canada to compare the therapeutic effects of CEA and CAS on extracranial carotid stenosis. From 2000 to 2008, a total of 2522 patients were included in the study. In the final clinical analysis, there were 65,438+0,262 patients in CAS group and 65,438+0,240 patients in CEA group, with an average follow-up time of 2.5 years. There was no significant difference between CAS group and CEA group (7.2% 7.2% vs 6.8%, P=0.5 1+0), and there was no significant difference between CAS group and CEA group in the incidence of major perioperative end points (5 P=0.38). Further stratified statistics showed that there was no significant difference in perioperative mortality between CAS group and CEA group (0.7% vs 0.3%). P=0. 18), the incidence of perioperative stroke in CAS group was significantly higher than that in CEA group (4.6438, but the incidence of perioperative myocardial infarction in CAS group was lower than that in CEA group (1.1%vs 2.3%, P = 0.03), and other subgroup analysis also suggested that the elderly were more suitable for CEA treatment.
Based on the research results of foreign countries for more than 20 years, CEA is clearly regarded as the first choice for the treatment of carotid atherosclerotic stenosis in the guidelines for stroke prevention and treatment in the United States and Europe, and CAS can achieve similar or even better results in special populations.
At the beginning of this year, the United States 14 professional association jointly issued the "Guidelines for the treatment of extracranial carotid and vertebral artery diseases: a joint guide of several scientific committees". While emphasizing the first choice of CEA, the indications of CAS should be relaxed appropriately, not only as a partial substitute for CEA, but also for asymptomatic patients with carotid artery stenosis (more than 60% in angiography and 70% in Doppler ultrasound), it is suggested that preventive treatment can be considered under high choice. At the same time, the perioperative safety of CEA and CAS is emphasized again, and the perioperative stroke or mortality must be less than 6%.
Characteristic treatment of carotid artery stenosis
Physical therapy plus traditional Chinese medicine therapy-Naotong Shuluoning suppository therapy
Under the guidance of the basic theory of traditional Chinese medicine, combined with the product of the development of modern science and technology, the treatment system of Naotong Shuluoning suppository has developed intelligent and standardized diagnosis and treatment equipment with the characteristics of traditional Chinese medicine by comprehensively applying the theory of traditional Chinese medicine, biomedical engineering, computer technology, information and sensor technology.
First, multi-disciplinary orientation, integrating the essence of Chinese and western medicine.
Include molecular genetics, cytopathology, nano-pharmacology, biophysics, molecular immunology, medical psychology and other disciplines. According to the World Health Organization (WHO) diagnosis and treatment standards for encephalopathy, based on the international authoritative diagnosis and treatment standards for cerebral thrombosis, cerebral infarction and cerebral ischemia, and combined with the characteristics of traditional Chinese medicine, the rehabilitation project "Naotong Shuluoning Suppository Therapy" was developed.
Second, multi-dimensional customization and "one-on-one" targeted treatment.
Take the lead in proposing a multidimensional stereoscopic treatment system for cerebral thrombosis, cerebral infarction and cerebral blood supply insufficiency. According to the principle of "one-to-one" targeted treatment, a personalized comprehensive treatment plan is formulated for each patient, and the most effective, safest and fastest treatment system is made by using the target positioning of "Yundian Monao Functional Circulation Therapeutic Apparatus" and combining the advantages and disadvantages of patients' own physique.
Third, comprehensively evaluate the condition and put an end to the damage of drugs to the body.
For the first time, a fully digital and accurate positioning system for cerebral thrombosis, cerebral infarction and cerebral blood supply insufficiency was introduced, which completely eradicated the harm caused by routine surgical treatment and drug treatment of cerebral thrombosis, cerebral infarction and cerebral blood supply insufficiency, without damaging liver and kidney function and leaving sequelae to patients' bodies.
Fourth, the treatment time is short and the rehabilitation effect is good.
Central nerve regeneration therapy can repair the damaged brain cells of patients in a short time, restore the blood supply and oxygen supply of brain lesions, activate damaged "dormant" brain tissue cells, and promote brain cell regeneration. After one week in hospital, 97% patients' brain function will be greatly improved. Combined with the later rehabilitation training and Chinese patent medicine conditioning, the rehabilitation effect is obvious, which completely solves the historical problem that cerebral thrombosis, cerebral infarction and cerebral blood supply deficiency cannot be cured.
diagnose
1.60 Men over 60 years old have long-term smoking history, obesity, hypertension, diabetes, hyperlipidemia and other risk factors for cardiovascular and cerebrovascular diseases.
2. Carotid artery murmur was found during physical examination.
3. Comprehensive analysis of the results of noninvasive auxiliary examination can make a diagnosis.
Common causes of carotid stenosis
atherosclerosis
It is the most common and involves bifurcation of common carotid artery, internal carotid artery and cavernous sinus, basilar artery and middle cerebral artery. The bifurcation lesions of common carotid artery often involve the distal end of common carotid artery and the proximal end of internal carotid artery, and the lesions mainly spread along the posterior wall of the artery, suggesting that local cerebral blood flow impacts the intima of blood vessels.
(2) Carotid fibromuscular dysplasia
It is a non-inflammatory vascular disease characterized by carotid and renal artery stenosis.
Common in white women aged 20-50. Bilateral carotid arteries and vertebral arteries are often involved at the same time, but bifurcation of common carotid arteries is often not involved (different from atherosclerosis). 20% ~ 40% patients have intracranial aneurysms.
(3) Carotid endarterectomy
There are two kinds: traumatic and spontaneous. The injured person overstretched his neck due to rotational violence, and the carotid artery touched the transverse process of the second cervical vertebra. Spontaneous patients are often accompanied by atherosclerosis and fibromuscular dysplasia. The typical manifestations of this disease on angiography are: the carotid artery at the distal end of the bifurcation of the common carotid artery is bird-beak-shaped stenosis or obstruction, which can extend to the skull base, sometimes accompanied by aneurysm.
accessory examination
Doppler ultrasound examination
Doppler ultrasound examination is an organic combination of Doppler blood flow measurement and real-time B-ultrasound imaging, and it is the first choice for non-invasive carotid artery examination at present, with the characteristics of simplicity, safety and low cost. It can not only display the anatomical image of carotid artery, but also display the arterial blood flow, velocity, blood flow direction and arterial thrombosis, such as distinguishing plaque hemorrhage from plaque ulcer. The accuracy of diagnosing the degree of carotid stenosis is over 95%, and Doppler ultrasound has been widely used in the screening and follow-up of carotid stenosis. Disadvantages of ultrasonic inspection include:
① Intracranial internal carotid artery lesions could not be examined;
② The test results are easily influenced by the technical level of the operators.
Magnetic resonance angiography
Magnetic resonance angiography (MRA) is a noninvasive angiography technique, which can clearly display the three-dimensional shape and structure of carotid artery and its branches, and can reconstruct the image of intracranial artery. The contour of neck blood vessels is relatively straight, which is especially suitable for MRA examination. MRA can accurately display thrombus plaque, dissecting aneurysm and intracranial artery, which is very helpful for diagnosis and scheme determination.
The prominent disadvantage of MRA is that slow or complicated blood flow often leads to signal loss and exaggerates stenosis. There are also some limitations in displaying hardened plaques. MRA is contraindicated for patients with metal retention (such as metal stents, pacemakers or metal prostheses). ).
Ct angiography
CT angiography (CTA) is a non-invasive angiography technique developed on the basis of spiral CT. The method is to inject contrast agent into blood vessels, scan the volume when the concentration of contrast agent in circulating blood or target blood vessels reaches the peak, and then process it to obtain digital stereoscopic images. Extracranial carotid artery is suitable for CTA examination, the main reason is that the direction of carotid artery is perpendicular to the CT section, which avoids the shortcoming of relatively insufficient resolution of horizontal blood vessels in spiral CT scanning. The advantage of CTA is that it can directly display calcified plaques.
At present, three-dimensional vascular reconstruction generally adopts surface shaded display (SSD) and maximum density projection MIP. MIP reconstruction images can obtain images similar to angiography, and can show calcification and mural thrombus, but the three-dimensional spatial relationship is not as good as SDD. But SDD can't directly show the density difference. CTA technology has been widely used in the diagnosis of carotid stenosis, but it is not mature enough and needs further experience to improve it.
Digital subtraction angiography
At present, although noninvasive imaging methods have been more and more widely used in the diagnosis of carotid artery lesions, each method has certain advantages and disadvantages. High resolution MRA, CTA and Doppler ultrasound imaging are of great value for initial diagnosis and follow-up. Although angiography is no longer the method of general survey, initial diagnosis and follow-up, digital subtraction angiography (DSA) is still the "gold standard" for the diagnosis of carotid artery stenosis in terms of accurately evaluating lesions and determining treatment plans.
DSA examination of carotid artery stenosis should include aortic arch angiography, bilateral common carotid angiography, intracranial carotid angiography, bilateral vertebral artery angiography and basilar artery angiography. DSA can know the location, scope and degree of the lesion and the formation of collateral in detail. Help determine the nature of lesions, such as ulcers, calcification and thrombosis; Understand the coexisting vascular diseases such as aneurysm and vascular malformation. Arteriography can provide the most valuable imaging basis for surgery and interventional therapy.
Arteriography is a traumatic examination method, and it is expensive. Literature reports that the incidence of complications is 0.3% ~ 7%. The main complications are cerebral vasospasm, stroke caused by plaque shedding, cerebral embolism and contrast agent allergy. Renal function injury, vascular injury, hematoma at puncture site, pseudoaneurysm, etc.
Determination of carotid artery stenosis
Although ultrasound, CT and MRI are playing an increasingly important role in the diagnosis of carotid artery stenosis, arteriography is still the "gold standard" for the diagnosis of carotid artery stenosis. Judging the degree of carotid stenosis according to the results of arteriography. Different research departments adopt different measurement methods. There are two commonly used measurement methods in the world, namely NASCET standard and ECST standard.
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