SYMPTOMS

What is carotid artery plaque?

Carotid artery plaque is a significant manifestation of carotid atherosclerosis, typically detected by doctors during imaging examinations, with written indications often found on the examination report.

Carotid artery plaques commonly occur at the bifurcation of the common carotid artery^[1], caused by the deposition of fats and calcium-like substances on the inner walls of the carotid artery. Studies suggest that approximately one-third of adults (aged 30–79) in China have carotid artery plaques^[2].

What are the symptoms of carotid artery plaque?

Whether carotid artery plaques cause symptoms depends on the time of onset and disease progression.

In the early stages, patients with newly formed plaques usually show no obvious symptoms, and the plaques are mostly discovered during ultrasound examinations.

If plaques block blood vessels, patients may experience symptoms such as dizziness, lightheadedness, and memory decline.

If plaques detach, they may travel with the bloodstream to cerebral blood vessels, blocking them and leading to ischemic stroke. Symptoms may include limb numbness, weakness in hands and feet, sensory disturbances, slurred speech or inability to speak, and blurred vision. Detached carotid artery plaques are a severe medical emergency and can be life-threatening.

How common is carotid artery plaque?

According to researchers' statistics and estimates, in 2020, about 21.1% of the global population (aged 30–79) had carotid artery plaques^[3], meaning roughly one in five people worldwide may have this condition.

A 2017 study involving ten regions in China reported that about one-third of adults (aged 30–79) had carotid artery plaques^[2].

Who is at high risk for carotid artery plaque?

1. Middle-aged and elderly populations The occurrence of carotid artery plaques is strongly associated with aging, and the incidence is higher in older adults than in younger individuals.
2. Male populations Carotid artery plaques also correlate with gender. Across all age groups, men are more likely to develop plaques than women^[1].
3. People with underlying conditions Hypertension: Atherosclerosis is closely linked to high blood pressure, which can promote the formation of carotid artery plaques (CAP). The risk of stroke in hypertensive patients is four times higher than in those with normal blood pressure^[1]. Hyperlipidemia: Elevated blood lipids lead to the deposition of fatty substances on blood vessel walls, thickening them. Over time, this can form plaques and block blood vessels. Diabetes: Diabetes can cause microvascular damage, abnormal platelet function, and increased blood clotting, promoting the formation of carotid artery plaques. Obesity: Obese individuals face higher risks of chronic diseases like hypertension and diabetes, which can trigger plaque formation.
4. Smokers Toxic and harmful substances in tobacco can irritate blood vessel walls, damage the endothelium, and make blood vessels fragile, inducing plaque formation.

TREATMENT

How to Deal with Carotid Artery Plaque?

The treatment for carotid artery plaque should be tailored to each patient's specific condition.

For asymptomatic patients, lifestyle changes can help slow disease progression.

Patients with underlying conditions, such as hypertension, hyperlipidemia, or diabetes, should actively manage these primary diseases.

Sudden symptoms like headache, coma, difficulty swallowing, or speech impairment may indicate plaque rupture, requiring immediate medical intervention to save lives.

What Should Carotid Artery Plaque Patients Pay Attention to in Daily Life?

• Diet

Pay special attention to oil choices. Avoid excessive intake of animal fats like lard or bone marrow. Opt for oils that help lower lipids and inhibit atherosclerosis, such as olive oil or flaxseed oil^[4].

Consume more vitamin C-rich fruits and vegetables, like oranges, lemons, and strawberries, to promote cholesterol conversion into bile acids for excretion^[5].

• Quit Smoking and Limit Alcohol

Nicotine and tar in tobacco severely damage blood vessels^[1], so patients should quit smoking. Alcohol increases the risk of underlying diseases^[6] and should be restricted.

• Exercise

Patients should engage in moderate aerobic exercise, such as swimming, jogging, or badminton, 2–3 times weekly for at least 30 minutes per session.

• Manage Underlying Conditions

Hypertension, hyperlipidemia, and diabetes are major contributors to carotid plaque. Strict adherence to prescribed treatments and follow-ups helps prevent disease progression.

What Are the Treatment Options for Carotid Artery Plaque?

Medication: Treatment varies by individual. Never self-medicate based on non-professional advice. Consider coexisting conditions when prescribing drugs.

• Antihypertensive Therapy: For hypertensive patients, maintain blood pressure below 130/80 mmHg using drugs like benazepril combined with nitrendipine or amlodipine^[7].
• Lipid-Lowering Therapy: Aim for LDL-C below 2.0 mmol/L using statins (e.g., atorvastatin, rosuvastatin), fibrates (e.g., fenofibrate, bezafibrate), niacin, ezetimibe, or probucol^[8].
• Glucose Control: For diabetic patients, target fasting glucose at 4.4–7.0 mmol/L and non-fasting glucose below 10.0 mmol/L with metformin, sulfonylureas, glinides, α-glucosidase inhibitors, or DPP-4 inhibitors^[9].

Surgery: Required if plaque causes significant vessel narrowing and impairs cerebral blood flow. Asymptomatic patients typically don’t need surgery.

Can Carotid Artery Plaque Be Cured?

Complete cure is unlikely, but healthy habits and medical treatment can alleviate symptoms and slow progression. Preventing complications, like ischemic stroke leading to paralysis or speech impairment, is crucial.

How to Prevent Carotid Artery Plaque?

• Control Underlying Diseases

Patients with hypertension or diabetes must follow medical advice, monitor indicators regularly, and reduce plaque risk.

• Maintain a Healthy Lifestyle

Avoid high-fat, salty foods. WHO recommends ≤5g daily salt intake (about one bottle cap). Replace animal fats with heart-healthy oils like olive oil.

Engage in aerobic exercise (e.g., jogging, swimming) 2–3 times weekly for ≥30 minutes to improve circulation and prevent obesity.

DIAGNOSIS

What symptoms of carotid artery plaque require medical attention?

If symptoms such as dizziness, blurred vision, or restricted limb movement occur, seek medical attention as soon as possible.

If no other symptoms are present but carotid artery plaque is detected during a physical examination, further tests such as ultrasound, angiography, or physical examination should be conducted as directed by a doctor. Follow-up treatment and medication should strictly adhere to medical advice.

Which department should I visit for carotid artery plaque?

For carotid artery plaque, consult the neurosurgery, neurology, or vascular department. In case of sudden onset, visit the emergency department.

What tests are needed for carotid artery plaque?

• Physical examination

A physical examination is the most basic test. The doctor will first palpate and auscultate the neck to check for vascular murmurs. A neurological examination will then be performed to assess for limb movement disorders, speech difficulties, swallowing problems, etc.

• Blood tests (routine, biochemical) and urinalysis

These tests are used to check for other underlying conditions.

• Carotid Doppler ultrasound

Carotid Doppler ultrasound is one of the most common methods for evaluating carotid artery plaque. It uses high-frequency sound waves to assess plaque size, blood flow, and whether the vessel is obstructed. This non-invasive test is relatively low-cost and convenient for outpatient examinations.

• Neck MRI

Neck MRI typically refers to magnetic resonance imaging. It uses magnetic fields to scan the neck and detect any abnormalities.

• Angiography

Angiography usually refers to digital subtraction angiography (DSA). This test involves injecting a contrast agent to visualize blood vessels and determine the degree of stenosis. It is mainly used for patients with severe narrowing and is the gold standard for diagnosing carotid artery stenosis.

POTENTIAL DISEASES

What factors contribute to carotid artery plaque formation?

• Androgen influence

Current statistics show differences in the incidence of carotid artery plaques between males and females, leading the medical community to believe hormones may play a role in their formation^[1].

• Smoking

Toxic substances in tobacco, such as nicotine and tar, increase the risk of stroke, heart attack, and mortality, while also worsening carotid plaque progression^[1].

• Genetic factors

Studies indicate that carotid artery plaques have a high heritability, with genetics playing a significant role^[10].

• Obesity

Obesity raises the likelihood of underlying conditions and can trigger carotid plaque formation.

• Hypertension

Atherosclerosis is closely linked to hypertension, which is also the leading cause of stroke risk^[11].

• Diabetes

Abnormal pancreatic function in diabetes patients can thicken the blood, promoting plaque formation^[12].

• Human cytomegalovirus infection

This infection may cause abnormal blood lipids and vascular endothelial damage, contributing to carotid atherosclerosis^[13].

What risks can carotid artery plaques cause?

Carotid plaques can disrupt daily life and trigger severe diseases.

• Impact on daily life: Plaques may reduce blood flow to the head, causing headaches, dizziness, or fainting.
• Serious complications^[1]:
  1. Ischemic cerebrovascular disease: The 2018 China Stroke Prevention Report shows 50%-75% of such cases stem from carotid artery issues, with over 70% due to plaque rupture.
  2. Alzheimer's dementia: Microvascular abnormalities are common in these patients, who exhibit higher rates of carotid dilation, thickened intima-media, and plaque formation compared to other psychiatric conditions.
  3. Leukoaraiosis: A radiological term for white matter changes detected via CT/MRI, often linked to cognitive decline and serving as a marker of brain damage.