Today, CT and MRI examinations are increasingly used in physical examinations and general diagnosis and treatment. Many friends who have done head CT or MRI examinations will get “lacune cerebral infarction” referred to as “caval infarction”, such a test result.

As soon as they see the word “stalk”, most people will get nervous and think, “Am I having a cerebral infarction”?

On the other hand, is it necessary to treat “cavity infarction” and what drugs should be used for treatment? Everyone often gets different answers. Some doctors say: “Cavity infarction” does not need to be ignored; while some doctors prescribe both lipid-lowering statin and aspirin to prevent thrombosis for “cavitary infarction” patients.

In this article, let’s talk about whether “cavity infarction” is considered “cerebral infarction”? And do “cavity stems” need to take statins and aspirin?

“cavity infarction”≠”cerebral infarction”

from strict In a sense, “cavity infarction” and “cerebral infarction/cerebral infarction” are two distinct diseases.

First, there is a significant difference in lesion size between “cavity infarction” and “cerebral infarction”.

“Cavity infarction” is usually caused by the occlusion of very small arteries in the brain, so the lesions are often small in size. From CT or magnetic resonance images, the diameter is generally no more than 1.5 cm.

The “cerebral infarction” is mostly caused by thromboembolism in the large and medium-sized arteries in the brain, so the volume of the lesions will be relatively large.

Second, the clinical manifestations of “cavitary infarction” and “cerebral infarction” are significantly different.

In most cases, “cavitary infarction” does not cause particularly noticeable symptoms. Many people may never find out about this problem if they don’t do CT or MRI. Of course, there are also some “cavity infarction” that can cause symptoms, but it is indeed a relatively rare situation in clinical practice.

The “cerebral infarction” is different. “Cerebral infarction” is often characterized by limb paralysis, slurred speech and even life-threatening.

Third, the pathogenesis of “caval infarction” and “cerebral infarction” is very different.

Studies have found that the small artery “occlusion” that causes “cavity infarction” is often not the cause of atherosclerosis. caused. It is more related to factors such as aging and swelling of small arterial walls caused by high blood pressure or increasing age. Therefore, many people without dyslipidemia, diabetes, and atherosclerosis risk can also develop “cavity infarction”.

and “brain infarction” occurred The pathological basis is often the formation of thrombus on atherosclerotic plaques in large and medium-sized arteries.

It is precisely because “cavity infarction” is not necessarily directly related to atherosclerosis Therefore, it may not necessarily benefit from “anti-atherosclerotic” drugs therapeutically.

Do I need statin + aspirin for cavity infarction?

For patients who do have “cerebral infarction”, both statin and aspirin are basically required.

Statins are the most commonly used drugs for cholesterol-lowering therapy, mainly by reducing LDL cholesterol, the “bad cholesterol” that promotes atherosclerosis , to stabilize atherosclerotic plaque and protect cardiovascular and cerebrovascular.

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Aspirin mainly reduces the risk of thrombosis by inhibiting the activation and aggregation of platelets.

As we mentioned earlier, the occurrence of “cavity infarction” is often not associated with atherosclerosis. So, do people with “cavity infarction” need to take statins and aspirin?

In the Chinese Consensus on the Diagnosis and Treatment of Asymptomatic Cerebral Infarction issued by the Neurology Branch of the Chinese Medical Association, it is clearly stated:

Aspirin is not recommended for patients with asymptomatic single lacunar infarction without any vascular risk factors! Furthermore, there is also a lack of clinical evidence to definitively support the use of statins in these patients.

This consensus also specifically emphasizes not to over-treat asymptomatic “cavity infarction”!

That is, if you do not have symptoms such as paralysis, numbness, or slurred speech, nor cardiovascular risk factors such as hypertension, dyslipidemia, diabetes, etc., just do a CT scan Or magnetic resonance found “cavity infarction”, then, there is no need to take statin and aspirin!

However, clinically, there are not many patients who fully meet the above situation. After a certain age, everyone is more or less prone to abnormal blood pressure, blood lipids and blood sugar.

And the existence of “cavity stalk” reminds everyone, be sure to control these indicators!

Because, although the harm of “cavity infarction” is much lower than the real “cerebral infarction”, the population with “cavity infarction” is still better than those without “caval infarction”. Crowds are more prone to true “cerebral infarction”.

Studies show that for patients with “cavity infarction” and hypertension, it is especially important to control blood pressure! Reducing blood pressure variability in patients with “cavity infarction” can reduce the risk of “cerebral infarction”.

Pril-like or sartan-like drugs that act on the renin-angiotensin-aldosterone system and calcium antagonists “dipine-like” drugs are beneficial in reducing blood pressure Variability of antihypertensive drugs.

That is to say, for patients with “cavitary infarction” complicated by hypertension, it is necessary to strictly control the blood pressure, and it is recommended to use “Pulley” “, “sartan” or “dipine” antihypertensive drugs.

In clinical practice, patients with “caval infarction” complicated by elevated cholesterol or carotid plaque are also common.

When the low-density lipoprotein cholesterol (LDL-C) level of patients with “caval infarction” exceeds 3.4 mmol/L or a low Echo’s “soft patch”. At this time, it is often necessary to take a statin to lower cholesterol or help stabilize arterial plaque.

In general, unless there are clear cardiovascular “high risk” factors other than “cavity infarction”, aspirin is not required.

Only those with diagnosed diabetes, high cholesterol levels, chronic kidney disease, or “multiple” combinations of high blood pressure, high blood lipids, high blood sugar, and smoking People with cardiovascular risk factors such as advanced age are classified as “high-risk groups” for cardiovascular disease.

For people who meet these criteria, even if there is no “cavity infarction”, most of them need to take aspirin.

Therefore, whether you need to take aspirin or not, it often has little to do with the existence of “cavity infarction”, and more depends on the overall cardiovascular risk. not tall.

Finally, it should be emphasized that patients with “cavity infarction” who have symptoms such as limb paralysis, numbness or slurred speech must be careful ! Be sure to go to the hospital in time for regular examination and treatment!

[Science popularization is for reference only, please seek medical attention if you feel unwell! ]