Epidemiological findings show that stroke has become the first cause of death and disability in China, with 1.7 million stroke deaths per year in 2010 and stroke related deaths accounting for about 20% of total deaths, 4-6 times more than in Europe, the United States and Japan. The stroke situation in China has the following three characteristics: 1. The regional differences are obvious (the western and northern regions in the alpine zone are significantly higher than the eastern and southern regions in the temperate and subtropical zones). 2. Against the background of a declining trend year by year in developed countries, the first stroke rate in China is bucking the trend, with 2.5 million new cases per year. The number of stroke patients in China is expected to increase nearly fourfold between 2010 and 2030, with the total number expected to reach 31.77 million. 3. Most of them are ischemic strokes (about 70%). 4. The recurrence rate of stroke is also significantly higher than that in western developed countries due to various reasons for poor secondary prevention. Therefore, the situation of the “war on stroke” (especially ischemic stroke) in China is very serious: not only the primary defense line is very tight, but also the secondary defense line is in a tug-of-war and stalemate. This is an extremely abnormal and unreasonable phenomenon. Because, both from the point of view of military defense and from the point of view of logical thinking, the hottest point of a blockade should not occur on the second line of defense. This illustrates a major strategic and tactical error in the deployment of stroke defense in China, which is reflected in the following three aspects: 1) The nation is overcrowded with stroke inpatients in large, medium and small hospitals, but the national knowledge of stroke basics and prevention is low. 2. Even among specialists and non-specialists in medical institutions, the concepts of stroke screening and prevention vary widely, and many advanced concepts and guideline recommendations are not effectively implemented. 3. The state has not done enough to mobilize for war in terms of policy making, economic support, research investment and public opinion propaganda, and has entrusted the task of national health education, which should be taken up, almost entirely to the increasingly tired clinicians. Marx pointed out in the Introduction to the Critique of Hegel’s Philosophy of Law: “The weapon of criticism is certainly no substitute for the criticism of the weapon”. Although material force can only be destroyed by material force, a good theory, once grasped by the masses, will also become a powerful material force. This philosophy can also be applied to the ischemic stroke “war of attrition”: on the one hand, we have to develop advanced weapons (good theories), and on the other hand, we have to mobilize the masses to consciously master and use them. As mentioned above, a simple modification of transcranial Doppler (TCD) technology (simply extending the detection time from the usual minutes to ≥30 minutes) can effectively monitor the microembolic signals (MES) circulating in the arteries, thus providing clinicians with highly valuable “battlefield information” to “stop” ischemic strokes. “battlefield information”. Therefore, MES monitoring is of great tactical value in the prevention and treatment of ischemic stroke. So, who should have this test? Combining the literature and my own clinical experience, I personally believe that this test should be done regularly in at least the following patients: 1. Those who have had at least one transient ischemic attack (TIA) with proven multiple ischemic cerebrovascular disease risk factors such as advanced age, hypertension, diabetes mellitus, hyperlipidemia, and smoking. 2. Patients who have had at least one stroke and have recently had recurrent aura. MES monitoring results in such patients can be used as an early warning sign for stroke recurrence and a reflective clue to find failure of secondary prevention measures. 3. Patients with recurrent strokes, but the cause is less clear. The MES results of such patients can be used as a clue to trace the cause of stroke. 4, Although there are no clinical symptoms, patients with ECG, vascular and cardiac ultrasound, MRI or CT angiography suggesting atrial fibrillation, structural abnormalities of the heart valves or endocardium and myocardium, and intracranial and external arterial stenosis, especially moderate to severe stenosis. The results of MES monitoring in such patients can be used as a basis for selecting the means, methods, intensity and frequency of follow-up for primary prevention interventions. 5. Patients with multiple ischemic cerebrovascular disease risk factors and progressively worsening speech ambiguity, swallowing disorders, gait abnormalities, cognitive decline, and personality changes are clinically detected despite the lack of a clear history of stroke. MES monitoring in such patients can be investigated as the cause of the above symptoms. 6. Patients who have been taking ischemic stroke prophylactic medication for a long time, in adequate dosage and within the framework of the latest prevention guidelines, but still cannot effectively avoid the occurrence of TIA or ischemic stroke. MES monitoring in such patients can be used as a screening for drug type and dose, and assessment of preventive value. 7. The ultra-early stage of ischemic stroke is an ideal window for receiving arterial and intravenous thrombolytic therapy. MES monitoring before, during, and after thrombolytic therapy can help assess the effect of thrombolytic therapy in real time and provide a scientific basis for subsequent treatment selection. The second question that needs to be answered is how to determine the timing and density of MES monitoring for different patients? No unified expert consensus has been reached on this point. However, extrapolating from the clinical significance of MES presence for ischemic stroke and the sensitivity and reliability of current TCD devices for MES, the following basic principles should be followed: 1. Complete MES monitoring within the shortest possible time after the onset of symptoms. 2. Any patient with ischemic stroke in whom arterial-arterial or cardiac-arterial embolism is suspected must undergo at least one MES monitoring if conditions permit. 3. Patients with proven intracranial and extracranial arterial stenosis and clinical and laboratory evidence supporting that the plaque causing the stenosis is in an unstable state are required to undergo monitoring at least 1-2 times per year. 4. The greater the number of risk factors for ischemic cerebrovascular disease, the more frequent the monitoring frequency needs to be. 5.Patients who have ever had a positive MES and the stronger and more frequent the signal, the more frequent monitoring is needed. 6. For patients whose goal is to find the cause and pathogenesis, select the treatment and type of drugs, and assess the risk of recurrence, MES monitoring should be completed at least once in the shortest possible time. In conclusion, MES monitoring is an effective weapon to “stop” ischemic stroke, i.e., it can be used for both primary and secondary prevention. It can be used as a diagnostic tool as well as a therapeutic tool and as an assessment and screening tool. Because of its simplicity, practicality, convenience and reliability, it will play a positive role in the overall strategy of ischemic stroke prevention and treatment in China once it is widely used in hospitals and patients at all levels.