This study is a prospective, single center cohort study. By combining pathological examination of carotid atherosclerotic plaque with preoperative imaging examination, we explore the imaging characteristics of high-risk carotid plaque, and explore the effectiveness and safety of different surgical methods (CAS and CEA) for high-risk plaque patients with carotid stenosis.

According to the inclusion and exclusion criteria, 100 patients with carotid artery stenosis who underwent surgical reconstruction surgery at our research center were prospectively collected from December 2023 to December 2024. Preoperative laboratory examinations such as blood routine, biochemistry, coagulation, and imaging examinations such as carotid artery ultrasound and TCCD, carotid artery ultrasound contrast, high-resolution MRI, head MRI plain scan, carotid artery CTA or DSA were completed, Based on the comprehensive evaluation of the patient's condition by the supervising physician, the appropriate surgical method (CEA or CAS) is selected. Follow up will be conducted 1/3/6/12 months after surgery to evaluate the incidence of endpoint events (cerebral infarction+all-cause death+postoperative restenosis), MoCA and MMSE cognitive scores, quality of life scores, and severe perioperative complications. At the same time, for patients undergoing CEA surgery, pathological examination of the postoperative carotid artery plaque will be conducted to clarify the nature of the plaque, and combined with imaging examination, the characteristics of high-risk carotid artery plaques will be studied

Inclusion Criteria:

1. The patient is aged 45-85 years old;
2. Symptomatic patients with stenosis degree greater than 50%, or asymptomatic patients with stenosis degree between 70% and 99% (ultrasound, CT or contrast);
3. Can complete regular follow-up;
4. The patient is informed and agrees to participate in the study.

Exclusion Criteria:

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1. Patients with spontaneous intracranial hemorrhage within the past 12 months;
2. Patients with larger intracranial aneurysms (diameter>5mm) that cannot be treated in advance or at the same time;
3. Patients with chronic complete occlusion without obvious symptoms of cerebral ischemia;
4. Patients with severe dementia;
5. Carotid artery opening lesion;
6. Severe intracranial serial stenosis lesions;
7. Carotid artery dissection;
8. Lesions with combined carotid artery aneurysm;
9. Patients with generally poor physical condition who cannot tolerate surgery;
10. Coagulation dysfunction, contraindications to heparin and antiplatelet drugs;
11. Patients who are participating in clinical trials of other drugs or devices but have not reached the trial endpoint;
12. Pregnant and lactating women;
13. The researchers believe that patients who are not suitable to participate in this trial.