I. Basic theory of acute cerebral infarction: 1. Classification Atherosclerotic type of aorta. Cardiogenic infarction type. Small artery occlusion type. Other causes of acute stroke, such as hypercoagulable state and blood disease. 2.”Ischemic semi-dark zone” theory: after cerebral artery blockage, serious blood shortage in ischemic center area can cause irreversible damage within minutes, but brain tissues in the ischemic semi-dark zone around it can still survive for several hours although they lose normal synaptic transmission function. If the blood flow of local brain tissue can be restored in time, the neurological function can be improved. Second, the timing of thrombolytic therapy: 1, the time limit of thrombolytic therapy: nerve cells are extremely sensitive to hypoxia. Practice has proved that when the local cerebral blood flow is kept above 30ml/100 g, the cerebral nerve function is not significantly affected; only when the cerebral blood flow is lower than 8-10ml/100g, irreversible necrosis of brain cells will occur. Therefore, the impairment of neurological function within a certain period of time is not equal to the death of nerve cells, because the nerve cells in the semi-dark area of cerebral infarction retain part of the blood supply due to the existence of collateral circulation, but today can survive for 4-8 hours, an average of 6 hours. This is the basic time basis for clinical thrombolytic therapy. 2, imaging characteristics: cranial CT scan within 3-5 hours after the occurrence of cerebral infarction often does not have obvious signs of cerebral infarction, except for intracerebral hematoma and subarachnoid hemorrhage, which is an important condition for thrombolytic therapy. The differentiation between TIA and early cerebral infarction: the majority of TIA episodes do not last more than 1 hour, and if it lasts more than 2 hours, less than 2% of the cases can recover on their own. Therefore, when the onset of hemiplegia is longer than 2 hours, active thrombolytic therapy should be used to obtain the earliest reperfusion, rather than passively waiting for its own recovery. Thrombolysis for basilar artery occlusion: Since the mortality rate of vertebral basilar artery occlusion is as high as 50%, intra-arterial thrombolysis can be prolonged to start the treatment within 24 hours. Since vertebral basilar artery stroke has the characteristics of clinically progressive aggravation, and the outcome is mainly dependent on the amount of brainstem function that has been impaired, rather than the onset of the disease to the time of treatment, therefore, there is no limitation on the time of treatment but rather on the clinical performance before treatment, and it is thought that deep Therefore, the time of treatment was not limited but the clinical manifestations before treatment, and deep coma and de-cerebralization for more than 6 hours were considered as contraindications. Third, the choice of thrombolytic drugs: commonly used thrombolytic drugs are SK UK r-tPA. SK and UK are non-specific thrombolytic drugs, and r-tPA has fibrinolytic specificity. SK and European and American studies have shown that the efficacy of SK is poor, and symptomatic cerebral hemorrhage and mortality rate have increased significantly, so the intravenous and arterial SK thrombolytic therapy should be given up. UK drugs are safer and cheaper, but individual differences are large. They are inexpensive, but there are large individual variations, ranging from 200,000-1,200,000 dollars. The average is about 500,000. r-tPA thrombolytic effect is good, but the price is more expensive, the general dosage is between 20-100mg. Indications and contraindications: 1. Indications: exact onset time within 6 hours; vertebral basilar artery system can be Extended to 12-24 hours. Behavioral indicators of muscle strength below grade 4 on the affected side or significant aphasia. Age: 75 years or less. ④No serious cardiac or pulmonary disease or bleeding disorder. ⑤ Blood pressure is controlled between 170 mmHg-110 mmHg. ⑥ Signed consent of the patient or family members. 2.Contraindications: Clinical manifestations have shown significant improvement before thrombolysis. Active bleeding and known bleeding tendency. Intracranial aneurysm, arteriovenous malformation, intracranial tumor and suspected subarachnoid hemorrhage. ④ History of cerebral hemorrhage, history of cerebral infarction in the current six months (with manifestations such as significant limb paralysis) and history of intracranial and spinal surgical trauma. ⑤ Active peptic ulcer or gastrointestinal bleeding in the current six months, acute myocardial infarction and infective endocarditis in the current three months, and surgery, delivery organ biopsy, and severe infection in the current six months. (vi) Severe cardiac insufficiency, septic thrombophlebitis, diabetic retinitis, and severe hepatic insufficiency. (7) Pregnancy. (8) Use of anticoagulants such as heparin and bicoumarin. ⑨ uncontrolled hypertension, systolic blood pressure >200mmHg or diastolic blood pressure >110mmHg. ⑩ systolic blood pressure <100mmHg (especially age 60 years old and above) is suspected of cerebral infarction due to hemodynamic disorders. V. Angiographic typing of acute occlusion of cerebral arteries (Theron, 1989): Type I: Occlusion of intracranial or extracranial arteries, but patency of the Ring of Willis and Bean stripe arteries. Mainly hemodynamic changes. Type II: Cortical vascular occlusion without involvement of the beanstripe artery. Type III: occlusion of all vessels involving the beanstripe artery. Type IIIa: partial occlusion of the lateral bean-striated artery; recanalization of this group of vessels results in only a small amount of bleeding, but rarely causes clinical symptoms. Type IIIb: complete occlusion of the bean-striated arteries by emboli. Type IIIc: complete occlusion of the internal carotid artery from its origin to the intracranial beanstripe artery. According to the typing, the thrombolytic effect is better and the complication rate is bottomed out for patients with type I-II, while the risk of bleeding increases after type III thrombolysis. Timing of thrombolysis and establishment of green channel: "Time is brain", recanalization of occluded blood vessels as early as possible and restoration of normal blood perfusion are the goals of intra-arterial thrombolysis, and the efficacy and complications of intra-arterial thrombolysis have a clear relationship with the time of onset of the disease. Our hospital must establish a fast channel for acute cerebral arterial thrombosis via intra-arterial thrombolysis, i.e. "green channel". 1, the emergency system, from the onset of the patient to the emergency room within one hour. 2. Experienced neurologists specializing in neurological emergencies, skilled in the selection of indications for intra-arterial thrombolysis, able to make an accurate judgment of whether to carry out intra-arterial thrombolysis within 30 minutes, and carry out routine examinations such as blood series, coagulation series and electrocardiograms while the patient undergoes CT examination. 3.Radiology department provides CT scanning 24 hours a day and makes CT diagnosis of patients within 10-15 minutes. 4.Interventional department arrives at the catheterization room within half an hour after the decision of intra-arterial thrombolysis is made in the emergency room. 5.After intra-arterial thrombolysis, the patient is added to the intensive care unit, and postoperative conservative treatment is given according to the degree of condition. 6.Part of the patients in the postoperative vascular ultrasound test to observe the status of vascular patency, there is no vasospasm, in order to timely treatment. 7, postoperative residual neurological dysfunction, after the stabilization of the condition in a timely manner for rehabilitation. At present, some patients' family members know the benefits of intra-arterial thrombolysis, but a large part of the people still do not know about intra-arterial thrombolysis, which needs to be publicized through the media and various means of publicity to the public about our hospital's acute cerebral arterial thrombosis by intra-arterial thrombolysis fast track, i.e., the "green channel" features. Characteristics.