After the “King of Skits” Zhao Benshan was hospitalized in Shanghai for interventional treatment due to “ruptured brain aneurysm and bleeding”, in November 2009, Mr. Yan Shunkai, a famous performing artist who played the role of Ah Q in “The Legend of Ah Q”, was hospitalized due to cerebral blood vessel stenosis and cerebral thrombosis. “He was hospitalized with a sudden onset of cerebral infarction and developed left-sided hemiplegia, inability to speak, and confusion. Later by the traditional method of conservative treatment and timely rescue of internal medicine although out of life threatening, but failed to avoid the occurrence of cerebral infarction, cerebral infarction body hemiplegia so that Q – Yan Shunkai can no longer walk on the stage of literature and art. Cerebral vascular stenosis caused cerebral ischemia cerebral infarction, resulting in the famous actor Yan Shunkai lifelong hemiplegia crippled. Atherosclerosis is the main cause of cervical cerebral artery stenosis occlusion. The more the number of stenosed arteries, the higher the incidence of stenosis events; arterial stenosis in Chinese people is most likely to occur in the intracranial middle cerebral artery, the intracranial segment of the internal carotid artery, the beginning segment of the internal carotid artery, the beginning segment of the vertebral artery, the confluence of the vertebrobasilar artery and the basilar artery; stenosis or occlusion occurs in the carotid artery system accounting for 4/5, and the vertebrobasilar artery system accounting for 1/5. 1, cerebral ischemia – cerebral infarction introduction Cerebrovascular disease has become the number one killer threatening the lives of Chinese people, seriously threatening the lives and physical health of middle-aged and elderly people. Since 2007, cerebrovascular disease has overtaken malignant tumors as the number one mortality and disability rate among all kinds of diseases that kill Chinese people, a result that has shocked the world. Perhaps China’s huge population base of 1.3 billion people is not afraid to die by millions, tens of millions or even hundreds of millions, but what should be done if tens of millions of people are paralyzed, and what should be the ordeal of tens of millions of families who are dragged by paralyzed patients. Cerebral artery stenosis – cerebral ischemia occurs in cerebral infarction is the most likely vascular lesion in Chinese people, i.e., yellow people, and can develop at any age, mostly in middle-aged and elderly people aged 50 to 70, with more men than women. It can occur in both the cervical and intracranial arteries, with cerebrovascular stenosis most often seen in the cervical arteries in the United States and European whites and in the intracranial arteries in our Chinese yellow population. Cerebrovascular stenosis is almost always a disease arising from long-term unhealthy living habits, the four major factors, namely long-term hypertension, hyperglycemia or hyperlipidemia, or long-term smoking causing atherosclerosis, intravascular atheromatous plaque causing vascular stenosis, severe stenosis (carotid lumen stenosis rate >75%, intracranial artery stenosis rate >50%) causing insufficient blood supply to brain cells, ischemic degeneration necrosis of brain cells, and cerebral infarction occurring. Once the precious and delicate human brain tissue brain cells are ischemic and necrotic, any treatment will not regenerate and repair them, the brain cell structure and function will be permanently lost, and various functions originally governed by brain tissue in the necrotic area, such as speech and limb activities, will also be lost forever, and the human body will be permanently disabled and can only drag the family relatives for a lifetime. 2, cerebral ischemia – cerebral infarction hazard cerebral artery stenosis cerebral ischemia is mostly secondary to thrombosis on the basis of narrowing of blood vessels, the patient often in a few seconds – a few minutes of impaired physical activity, loss of consciousness or into a coma. According to statistics from Europe and the United States, the drugs used to treat stroke have been replaced by 5-10 generations in the past 30 years, and the cost of drugs used to treat stroke has increased nearly 300 times, while the final treatment effect of stroke has not changed much, and the mortality and severe disability rates remain at 79%-90%. This includes a 79% mortality and disability rate in the anterior circulation (internal carotid system) and a 90% mortality and severe disability rate in the posterior circulation (vertebrobasilar system). This result is helpless to the medical community and frightening to the whole society. Brain cells are the most delicate cells in the human body, and brain cells are most sensitive to ischemia. 6-8 hours of ischemia in brain cells with internal carotid artery blockage, and 12-24 hours of ischemia in brain nerve fibers with vertebrobasilar artery blockage will be forever necrotic and liquefied, and will not be regenerated and repaired. Therefore, there is a clear time limit for treating cerebral ischemia, which must be opened before cerebral vascular stenosis, cerebral blood flow obstruction, and cerebral tissue ischemia and necrosis, and restore cerebral vascular blood flow to restore cerebral tissue blood supply; otherwise, beyond this time period, cerebral tissue will be necrotic forever. Thereafter, any treatment is impossible to save the brain cells and brain nerve fibers that have died. Cerebral ischemia with cerebrovascular stenosis almost always has an aura, and there are episodes of physical inactivity, unfavorable language, or loss of consciousness lasting from a few seconds to a few minutes to a few hours, mostly occurring in the morning when waking up, or when standing up suddenly from a lying or sitting position, and recovering after bed rest or treatment. This is called transient cerebral ischemia (TIA), which is a moderate to severe narrowing of the cerebral arteries, with a sudden increase in the amount of blood circulating in the body and a decrease in the amount of blood circulating in the brain, resulting in transient ischemia of brain tissue and abnormal brain cell function. In case of this presentation, cerebrovascular imaging (CTA or MRA of the superior arch artery) or/and cerebral perfusion imaging should be completed as soon as possible to confirm severe cerebrovascular stenosis, and cerebrovascular intervention should be done promptly before the occurrence of sustained cerebrovascular ischemia. Interventional treatment at this time, called cerebrovascular stenosis stroke prophylaxis, is currently the most effective treatment technique. 3.Diagnosis of cerebral ischemia – cerebral infarction Patients with sudden onset of sensory impairment of one limb, cerebral nerve injury, impaired movement of one limb, loss of speech or loss of consciousness rapidly progressing to coma state, lasting for several minutes to several hours without relief, should undergo cerebrovascular imaging examination as soon as possible, such as multi-row CT superior arch artery CTA, or high field intensity magnetic resonance superior arch artery MRA, or direct interventional whole brain angiography. If possible, CT or MR cerebral perfusion (diffusion) imaging should be performed at the same time to determine the degree of cerebral tissue ischemia or whether the brain cells are ischemic or necrotic, so that effective interventional treatment can be implemented as soon as possible. CTA of the superior arch artery (craniocervical) can completely replace whole brain angiography in the diagnosis of cerebral artery stenosis. Magnetic resonance angiography (MRA) of the superior arch artery (craniocervical) without radiation is also valuable in the diagnosis and follow-up observation of cerebral artery stenosis. Those with >75% stenosis of the carotid and intracranial arteries should be treated as soon as possible with intervention to release the stenosis. 4.Cerebral ischemia – cerebral infarction treatment With the rapid development and technology popularization of non-invasive cerebrovascular imaging techniques CTA and MRA in recent years, more and more cervical cerebral artery stenosis or occlusion are detected in time. Before the occurrence of cervical cerebral artery stenosis-brain ischemia, the brain ischemia time is short and the brain cells are not yet ischemic necrosis (the time window to protect the brain) minimally invasive endovascular intervention techniques, successful treatment of these cerebral ischemic emergencies can be realized, and patients with ischemic stroke are completely recovered. Once the symptoms of cerebral ischemia occur in severe stenosis of the carotid artery, we should try to open the narrowed and blocked cerebral vessels to restore the normal blood supply to the brain before the brain cells become necrotic. The most common cerebral ischemia in Chinese people is the combination of stenosis and thrombosis, and the local blood flow is completely blocked. It is difficult for the thrombolytic drugs entering the blood vessels through intravenous infusion to reach the cerebral arteries in the area of blood flow blockage, or the amount of thrombolytic drugs reaching the blood vessels is extremely small, which is not enough to dissolve the thrombus quickly and effectively, so the effect of medical treatment for cerebral thrombosis has been unsatisfactory for decades. (1) Catheter contact thrombolysis, modern interventional techniques insert the catheter directly into the thrombus area and inject the thrombolytic drug directly into the thrombus through the catheter, a large amount of thrombolytic drug enters the thrombus, the thrombus dissolves in a very short time (within 10-30 minutes) and the blood vessel is reopened to restore blood flow. (2) Internal stent placement, severe stenosis of carotid cerebral artery with cerebral ischemia, insert catheter to cerebral vascular stenosis area by interventional technique, deliver internal stent to arterial stenosis area through catheter, release internal stent to expand arterial stenosis, restore normal lumen of cerebral artery and restore blood supply to brain tissue. If the stenosis is combined with thrombosis, the stenosis can be dissolved by injecting thrombolytic drugs into the catheter first, and then the internal stent can be implanted to release the arterial stenosis; or the internal stent can be placed directly to compress and crush the thrombus and release the arterial stenosis at the same time. 5.Prognosis of cerebral ischemia and cerebral infarction The outcome of interventional treatment for cervicocerebral artery stenosis and cerebral ischemia is related to the presence or absence of other diseases (hypertension, hyperglycemia, hyperlipidemia, smoking, etc.), the degree and extent of cerebral vascular sclerosis, the choice of interventional time window after the occurrence of cerebral ischemia, the experience and technical proficiency of the interventional therapist, the cooperation of nurses and anesthesiologists during the interventional operation, the period of interventional surgery and post-surgery, and the ability of the patient’s blood pressure and heart function control. The patient’s blood pressure and heart function control and monitoring, and the effective and timely management of various complications after the intervention are all closely related to the prognosis. As long as we open the narrowed or occluded cervical cerebral artery before ischemic necrosis occurs in the brain tissue and release the cerebral artery stenosis to restore cerebral blood supply, the patient can be completely cured without sequelae. Chinese doctors are leading the world in interventional treatment of intracranial artery stenosis, or stenosis combined with thrombosis. Cerebrovascular intervention is not a one-time operation by one person, but a team (doctors, nurses, technicians) working closely together, treating a patient requires a week or half a month of careful operation and careful observation. 6.Cerebral ischemia-brain infarction prevention Neuroepidemiological studies, the main pathogenic risk factors of ischemic cerebrovascular diseases are: persistent hypertension, heart valve disease or abnormal heart rate, diabetes, high cholesterol and high blood lipid, long-term smoking, etc. leading to atherosclerosis. Prevention and early treatment of these underlying diseases and removal of adverse lifestyle habits such as resolute smoking cessation are the most effective measures to prevent ischemic stroke and to achieve long-term interventional efficacy.