Carotid Atherosclerotic Plaques and Acupuncture Treatment in Tokyo

Understanding Carotid Atherosclerotic Plaques

What Are Carotid Atherosclerotic Plaques?

Carotid atherosclerotic plaques result from atherosclerosis, a chronic inflammatory condition characterized by the buildup of plaques in arterial walls. The carotid arteries, located on either side of the neck, are particularly vulnerable because they are critical for brain circulation. Plaques consist of lipids, cholesterol, calcium, and inflammatory cells, which harden and narrow the arterial lumen over time. This process, known as stenosis, restricts blood flow and increases the risk of embolic events if plaques become unstable and rupture.

Causes and Risk Factors

Several factors contribute to the development of carotid atherosclerotic plaques:

• High Cholesterol Levels: Elevated low-density lipoprotein (LDL) cholesterol promotes plaque formation.
• Hypertension: High blood pressure damages arterial walls, making them more susceptible to plaque buildup.
• Smoking: Tobacco use accelerates atherosclerosis by promoting inflammation and oxidative stress.
• Diabetes: Poorly controlled blood sugar levels impair vascular health.
• Obesity and Sedentary Lifestyle: Excess weight and lack of exercise contribute to lipid imbalances and inflammation.
• Genetic Predisposition: Family history of cardiovascular disease increases risk.
• Age and Gender: Risk rises with age, and men are generally more susceptible than premenopausal women.

Symptoms and Complications

In its early stages, carotid atherosclerosis is often asymptomatic. As plaques grow, they may cause:

• Transient Ischemic Attacks (TIAs): Brief episodes of stroke-like symptoms, such as numbness, weakness, or difficulty speaking.
• Stroke: A major complication caused by plaque rupture or blood clots blocking cerebral blood flow.
• Dizziness or Syncope: Reduced blood flow to the brain can cause lightheadedness.
• Vision Problems: Temporary vision loss in one eye (amaurosis fugax) may occur.

Untreated carotid atherosclerosis can lead to severe disability or death, underscoring the need for early detection and management.

Conventional Treatments

Standard treatments aim to slow plaque progression, stabilize plaques, and prevent complications:

• Lifestyle Changes: Adopting a heart-healthy diet, exercising regularly, quitting smoking, and managing stress.
• Medications: Statins to lower cholesterol, antiplatelet drugs (e.g., aspirin at 75–150 mg/day) to prevent clotting, and antihypertensives to control blood pressure.
• Surgical Interventions: Carotid endarterectomy or stenting for severe stenosis.

While effective, these treatments have limitations. Medications can cause side effects like gastrointestinal issues or muscle pain, and surgical procedures carry risks. This has led to growing interest in acupuncture as a complementary therapy.

Acupuncture for Carotid Atherosclerotic Plaques

Acupuncture involves inserting thin needles into specific points on the body, known as acupoints, to restore balance and promote healing. According to TOM, health depends on the harmonious flow of energy and blood through meridians, or energy channels. Blockages or imbalances in these channels can lead to disease. Acupuncture aims to correct these imbalances by stimulating acupoints, which are believed to influence organ function, blood flow, and inflammation.

Modern research suggests acupuncture may work by modulating the nervous system, releasing endorphins, and reducing inflammation. For cardiovascular conditions like carotid atherosclerosis, acupuncture is thought to improve blood circulation, regulate lipid metabolism, and stabilize plaques.

How Acupuncture Addresses Carotid Atherosclerotic Plaques

Acupuncture offers several potential benefits for managing carotid atherosclerotic plaques:

1. Improved Blood Flow: Acupuncture may enhance microcirculation and reduce blood viscosity, facilitating better oxygen delivery to tissues. Studies have shown that acupuncture can regulate high and low shear blood viscosity, reducing friction in blood vessels.
2. Plaque Stabilization: Acupuncture may increase the grey-scale median (GSM), a marker of plaque stability, by promoting fibrotic tissue and calcification in plaques. Stable plaques are less likely to rupture.
3. Anti-Inflammatory Effects: Chronic inflammation drives atherosclerosis. Acupuncture has been shown to reduce pro-inflammatory cytokines and modulate immune responses, potentially slowing plaque progression.
4. Lipid Regulation: Some studies suggest acupuncture, when combined with medications like statins, can further reduce total cholesterol (TC), triglycerides (TG), and LDL cholesterol while increasing high-density lipoprotein (HDL) cholesterol.
5. Blood Pressure Control: Acupuncture at specific acupoints can lower blood pressure, reducing stress on arterial walls.
6. Reduced Plaque Volume: Clinical trials have reported significant reductions in plaque volume and carotid intima-media thickness (cIMT) in patients receiving acupuncture compared to sham acupuncture.

Evidence Supporting Acupuncture for Carotid Atherosclerosis

Several studies have investigated acupuncture’s efficacy for carotid atherosclerotic plaques:

• Randomized Controlled Trial (2024): A study published in BMC Complementary Medicine and Therapies found that 12 weeks of real acupuncture significantly reduced plaque score (PS), plaque volume (PV), and improved GSM compared to sham acupuncture. No significant difference was observed in cIMT or pulse wave velocity (PWV).
• Pilot Study Protocol (2020): A three-arm randomized trial in China compared true acupuncture (TA), sham acupuncture (SA), and medication (MC) groups. The study aimed to enroll 105 patients to assess total plaque volume (PV) and GSM using 3D ultrasound. Preliminary results suggested acupuncture’s potential to reduce plaque burden.
• Combined Therapy Study: Research combining acupuncture with TOM decoctions and atorvastatin showed greater reductions in cIMT, unstable plaque numbers, and plaque area compared to atorvastatin alone.
• Threading Acupuncture: A study comparing threading acupuncture, standard acupuncture, and simvastatin found threading acupuncture produced the greatest reductions in cIMT, indicating superior efficacy.

While these findings are promising, limitations include small sample sizes and the need for larger, high-quality trials. Acupuncture’s role as a single therapy or adjunct to conventional treatments requires further exploration.

Safety and Considerations

Acupuncture is generally safe when performed by trained practitioners. Side effects, such as mild bruising or soreness, are rare and resolve quickly. For carotid atherosclerosis patients, acupuncturists must differentiate between stable plaques and acute conditions like myocardial infarction to avoid complications. Patients with severe stenosis or recent strokes may require medical clearance before starting acupuncture.

Key Acupoints for Treating Carotid Atherosclerotic Plaques

Acupoint selection is critical in TOM, as different points target specific meridians and physiological functions. The following acupoints are commonly used for carotid atherosclerotic plaques, based on clinical studies and TOM theory:

1. Neiguan (PC6)

• Location: On the inner forearm, approximately two inches above the wrist crease, between the flexor carpi radialis and palmaris longus tendons.
• Meridian: Pericardium
• Function: Regulates heart function, reduces chest pain, and lowers blood pressure. PC6 is widely used for cardiovascular conditions, including angina and hypertension. It enhances coronary blood flow via collateral circulation and improves hemorheological parameters.
• Clinical Use: Studies show PC6 stimulation reduces heart rate and blood pressure, making it valuable for managing atherosclerosis-related hypertension.

2. Renying (ST9)

• Location: On the neck, lateral to the Adam’s apple, at the anterior border of the sternocleidomastoid muscle.
• Meridian: Stomach
• Function: Promotes smooth blood flow and reduces vascular tension. Renying is particularly relevant for carotid atherosclerosis due to its proximity to the carotid arteries.
• Clinical Use: Acupuncture at ST9 has been shown to lower blood pressure, reduce lipid levels, and stabilize plaques. It also has a calming effect, reducing patient discomfort.

3. Baihui (DU20)

• Location: At the top of the head, at the midpoint of the line connecting the apexes of both ears.
• Meridian: Governor Vessel (Du Mai)
• Function: Regulates energy and blood flow to the brain, improves cerebral circulation, and calms the mind. Baihui is often used for stroke prevention and rehabilitation.
• Clinical Use: DU20 is included in protocols for carotid atherosclerosis to enhance brain perfusion and reduce the risk of cerebrovascular events.

4. Yintang (EX-HN3)

• Location: On the forehead, midway between the eyebrows.
• Meridian: Extra Point
• Function: Calms the mind, improves circulation, and reduces stress, which can exacerbate atherosclerosis.
• Clinical Use: Yintang is used in stroke and atherosclerosis protocols to alleviate tension and support vascular health.

5. Yanglingquan (GB34)

• Location: On the lateral side of the lower leg, in the depression anterior and inferior to the head of the fibula.
• Meridian: Gallbladder
• Function: Regulates energy, promotes blood flow, and clears phlegm, which TOM associates with atherosclerosis.
• Clinical Use: GB34 is included in protocols to address phlegm-blood stasis, a TOM concept linked to plaque formation.

6. Zusanli (ST36)

• Location: On the anterior aspect of the leg, about four finger-widths below the knee, lateral to the tibia.
• Meridian: Stomach
• Function: Strengthens overall energy, improves circulation, and reduces inflammation. ST36 is a versatile point used for various cardiovascular conditions.
• Clinical Use: Studies confirm ST36’s role in lowering blood pressure and enhancing vascular function. It is often combined with other points for synergistic effects.

7. Fengchi (GB20)

• Location: At the base of the skull, in the depression between the sternocleidomastoid and trapezius muscles.
• Meridian: Gallbladder
• Function: Promotes blood flow to the head and neck, reduces blood pressure, and clears blockages in the meridians.
• Clinical Use: Fengchi is used to improve carotid artery patency and reduce stenosis.

8. Hegu (LI4)

• Location: On the hand, in the web between the thumb and index finger.
• Meridian: Large Intestine
• Function: Regulates energy and blood, reduces blood pressure, and improves heart function.
• Clinical Use: LI4 is associated with cardiovascular benefits, including hypertension management, making it a supportive point for atherosclerosis treatment.

TOM Perspective on Acupoint Selection

In TOM, carotid atherosclerosis is often attributed to “phlegm-blood stasis,” where stagnant blood and phlegm obstruct the meridians. Acupoints are selected to dredge these blockages, promote blood flow, and restore balance. For example, PC6 and ST9 target heart and vascular function, while DU20 and GB34 address cerebral circulation and phlegm clearance. Practitioners tailor acupoint combinations based on the patient’s symptoms, pulse diagnosis, and tongue appearance, ensuring individualized treatment.

Acupuncture Techniques

• Manual Acupuncture: Involves inserting needles and applying mild rotation or reinforcing-reducing techniques for 30 minutes per session.
• Electroacupuncture (EA): Applies a small electrical current to needles to enhance stimulation. EA at points like DU20 and ST36 has shown neuroprotective effects.
• Threading Acupuncture: Needles are inserted from one acupoint to another to target deeper tissues, producing superior reductions in cIMT.
• Sham Acupuncture: Used in research as a control, involving blunt needles or non-acupoint stimulation to isolate placebo effects.

Integrating Acupuncture with Conventional Treatments

Acupuncture is most effective when integrated with conventional therapies. For example:

• With Statins: Acupuncture enhances lipid-lowering effects, reducing TC, TG, and LDL-C more than statins alone.
• With Antiplatelet Drugs: Acupuncture may reduce the side effects of aspirin while improving its efficacy in preventing clots.
• With Lifestyle Changes: Acupuncture supports adherence to diet and exercise by reducing stress and improving energy levels.

Patients should consult their healthcare providers to create a comprehensive treatment plan that combines acupuncture with medical therapies.

Practical Considerations for Patients

Finding a Qualified Acupuncturist

• Choose a licensed practitioner certified by a recognized body, such as the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).
• Ensure the acupuncturist has experience treating cardiovascular conditions.
• Verify that sterile, single-use needles are used to prevent infections.

Treatment Frequency and Duration

Clinical trials typically involve 12 weeks of acupuncture, with two sessions per week. Maintenance sessions may be needed for long-term management. The exact schedule depends on the patient’s condition and response to treatment.

Future Directions and Research Needs

While current studies support acupuncture’s potential for carotid atherosclerotic plaques, more research is needed to:

• Conduct large-scale, multicenter randomized controlled trials to confirm efficacy.
• Explore the mechanisms of acupuncture, such as its effects on inflammatory pathways and lipid metabolism.
• Standardize acupoint protocols for consistent outcomes.
• Compare acupuncture’s cost-effectiveness with conventional treatments.

Ongoing trials, such as those registered on ClinicalTrials.gov, aim to address these gaps.

Conclusion

Carotid atherosclerotic plaques pose a serious risk to cardiovascular and cerebrovascular health, but acupuncture offers a promising complementary therapy. By improving blood flow, stabilizing plaques, and reducing inflammation, acupuncture can enhance conventional treatments and improve patient outcomes. Key acupoints like PC6, ST9, DU20, and ST36 target the underlying causes of atherosclerosis in TOM, such as phlegm-blood stasis, while supporting overall vascular health.

For individuals seeking a holistic approach to managing carotid atherosclerosis, acupuncture provides a safe, non-invasive option with minimal side effects. However, it should be integrated with lifestyle changes and medical therapies under professional guidance. As research continues to validate acupuncture’s benefits, it may become a standard adjunctive therapy for carotid atherosclerotic plaques, offering hope for better cardiovascular health.

If you or a loved one is concerned about carotid atherosclerotic plaques, consult our healthcare provider to explore acupuncture as part of a comprehensive treatment plan. Find a qualified acupuncturist near you and take the first step toward holistic cardiovascular wellness. Share this article to raise awareness about acupuncture’s potential in managing this silent but serious condition.

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