In China, the number of neurological diseases, mainly cerebrovascular diseases, has exceeded 2 million each year, and the mortality rate exceeds that of cardiovascular diseases and malignant tumors, and the disability rate is the highest among all kinds of diseases. At present, interventional treatment for cerebrovascular diseases is still a young discipline in the medical field, but it is increasingly recognized by doctors and patients for its minimally invasive, safe and low complications, especially in recent years with the continuous development of cerebrovascular anatomy research, electronic computer technology, imaging technology, angiography technology, catheters, embolic materials and non-ionic contrast agents, and various large-scale, multi-center, high-quality With the continuous development of cerebrovascular anatomy research, electronic computer technology, imaging technology, vascular imaging technology, catheters, embolic materials and nonionic contrast agents, and various large-scale, multicenter, high-quality clinical trials, the advantages of neurointerventional treatment have become increasingly prominent. I. Diagnostic cerebrovascular imaging techniques Most cerebrovascular angiograms are performed through femoral artery puncture and rapid injection of high pressure contrast agent into the selected artery via catheter, and selective and super-selective imaging is performed to obtain digital subtraction angiography (DSA) images. DSA shows the most complete and detailed normal anatomy of cerebral vessels, and is recognized as the gold or diamond standard for the diagnosis of cerebrovascular diseases at home and abroad. It can be used for the diagnosis of stenosis or occlusion of arteries in the cervical and intracranial segments, vascular malformations, aneurysms and other diseases. The latest technology is a single contrast 3D DSA imaging, which reduces both the examination time and the examination dose. The 3D image formed by it can be rotated at any angle and observed in real time, dynamically and in three dimensions, which makes the normal anatomy and lesions of cerebral vessels more clearly displayed and provides superior conditions for the diagnosis and interventional treatment of cerebrovascular diseases. At present, very few hospitals carry out cerebral angiography via radial artery pathway, which has the following advantages compared with other pathways: 1. The radial artery is superficial, easy to compress and stop bleeding, no important nerves and blood vessels around, no serious complications occur. 2. This is particularly convenient and beneficial for patients with lower extremity arterial ischemia. 3. The cost is significantly lower than the transfemoral route due to lower complication and support costs, and shorter hospital stay. This also reduces the financial burden for the patient. Interventional treatment of carotid stenosis in the extracranial segment Since the introduction of carotid endarterectomy (CEA) in 1953, it has gradually become the first-line option for the treatment of carotid stenosis. The subsequent development of carotid angioplasty and stenting (CAS) was initially used in patients who were not suitable for CEA, but with technical advances and experience, CAS has now become an important treatment for carotid stenosis and has been the subject of numerous clinical studies, with the results of two more recent clinical trials. The International Carotid Stenting Study (ICSS), published in Lancet in 2010, was a multicenter randomized controlled study of symptomatic carotid stenosis patients treated with CAS or CEA. The incidence of stroke and death at 30 days after surgery was significantly higher in the CAS group than in the CEA group (7.4% vs. 4.0%), and the incidence of asymptomatic cerebral infarction was significantly higher in the CAS group than in the CEA group in the subgroup analysis. The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), also published in 2010, is the largest multicenter randomized controlled trial to date comparing the efficacy of CAS versus CEA. The trial enrolled 2,502 patients in 117 centers and included both symptomatic and asymptomatic carotid stenosis patients. Unlike other clinical trials, this study included myocardial infarction among the trial endpoints. The results showed no significant difference in the incidence of the primary endpoint events (including stroke, infarction, and death) between the two groups (7.2% and 6.8%, P=0.51). perioperative stroke was higher in the CAS group (4.1% vs. 2.3%), while infarction was higher in the CEA group (2.3% vs. 1.1%). By subgroup analysis, it was found that CAS was more suitable for patients younger than 70 years of age, while CEA was more suitable for patients older than 70 years of age. It is evident that comparative studies of CAS versus CEA remain a hot topic for future research, and there is a lack of clinical trial results for long-term follow-up after CAS. Intracranial atherosclerotic disease is not a major cause of cerebral ischemia in Europe and the United States, and the incidence of intracranial artery stenosis in stroke and transient ischemic attack (TIA) is only 6-10%. However, the incidence of intracranial artery stenosis is relatively high in Asian populations and is associated with 30% to 50% of strokes, making it an important risk factor for cerebrovascular disease. Symptomatic intracranial artery stenosis >50% in the WASID trial, treated with aspirin or warfarin, still caused stroke rates of 12% and 11% in the first year. Stenting is used as a supplement to pharmacological therapy for stroke prevention, theoretically reducing the degree of intracranial artery stenosis and improving perfusion in the ischemic zone, potentially reducing the risk of stroke. The technical success rate of intracranial artery stenting is high, above 90%, and the results of the 2010 German multicenter INTRASTENT trial showed that the perioperative mortality rate for stenting combined with pharmacological treatment of intracranial artery stenosis was 2.2% and the incidence of disabling stroke was 4.8%; the incidence of postoperative bleeding was significantly higher in middle cerebral artery lesions than in other sites, but the incidence of serious complications was The incidence of bleeding after middle cerebral artery lesions is significantly higher than at other sites, but the incidence of serious complications is not related to the location of the lesion or the degree of stenosis. Although case series have been studied showing an incidence of ipsilateral recurrent stroke after stenting in the range of 1.9% to 3.8%, these cases were selected, and both case and stent selection were related to the nature of the patient’s lesion, lesion length, vessel pathway, and operator experience and preference. The Intracranial Stenting Versus Aggressive Pharmacologic Intervention for Intracranial Artery Stenosis Trial (SAMMPRIS), published in the New England Journal of Medicine in September 2011, is another large clinical study exploring the treatment of intracranial artery stenosis, following the WASID study.SAMMPRIS is the first study to compare aggressive pharmacologic treatment versus aggressive pharmacologic intervention in patients with high-risk intracranial artery stenosis (70% to 99%). SAMMPRIS is the first prospective, multicenter, randomized controlled trial to compare the effectiveness of aggressive drug therapy with aggressive drug therapy + intervention for recurrent stroke prevention in patients with high-risk intracranial artery stenosis (70%-99%). Although the SAMMPRIS study revealed certain patterns, they are not sufficient to fully prove a conclusion. For a risky therapeutic technique, a positive clinical trial result only partially confirms the hypothesis, whereas a negative result may be more meaningful and may help us to identify areas for improvement. A review of controlled studies of CEA and carotid stenting, from the Carotid Wallstent trial, which was discontinued 10 years ago because of the high complication rate of carotid stenting, to the CREST trial, where the two were matched, has shown that carotid stenting has come a long way and has finally reached a day of maturity, with almost identical treatment to CEA in stroke treatment guidelines. The recommendation. Will a similar situation occur in the field of intracranial artery stenting in a few years? IV. Interventional treatment of vertebral artery stenosis 20% to 25% of ischemic strokes occur in the posterior circulation, due to lesions in the vertebrobasilar system. The incidence of vertebral artery lesions is lower than that of carotid artery lesions, and since bilateral vertebral arteries converge to form the basilar artery, one vertebral artery lesion can be compensated by the contralateral vertebral artery, therefore, unilateral vertebral artery lesions do not necessarily have clinical manifestations. However, if bilateral vertebral artery lesions or one side of the vertebral artery is dysplastic, the patient may develop posterior circulation ischemia, which has a poor prognosis and high mortality. Vertebral artery lesions tend to occur at their origin and proximal segments. Due to the high complication rate of surgical treatment, interventional treatment of vertebral artery stenosis is mainly performed, and some clinical experience has been accumulated. Recently, Jenkins et al. reported a group of cases with long-term follow-up after interventional treatment of symptomatic vertebral artery stenosis. In this retrospective study, a total of 112 vertebral arteries (91% extracranial and 9% intracranial segments) were stented in 105 consecutive patients from 1995 to 2006. The technical success rate was 100% and the clinical success rate, i.e., symptom relief, was 90.5%. 100 patients were followed up with a median follow-up time of 29.1 months, 71.4% survived, and 70.5% were clinically symptom-free. Despite such good clinical results reported, there are still some unresolved issues in vertebral artery interventions, such as the effect of drug therapy on the natural course of vertebral artery stenosis and its comparative study with stenting; the treatment of bilateral vertebral artery stenosis, whether stents should be placed bilaterally or unilaterally; the clinical significance of the application of the distal umbrella during vertebral artery stenting, etc., which remains to be studied in the future. Further studies are needed. V. Interventional treatment of acute ischemic stroke Acute ischemic stroke is a serious threat to human health because of its high mortality and disability rate. The most recent published timelines for intravenous thrombolysis are The latest published time window for intravenous thrombolytic therapy has been extended to 4.5 h after onset, and patients can still benefit. However, only 3-10% of acute ischemic stroke patients receive intravenous thrombolytic therapy, and the revascularization rate is only 10-30% when they receive thrombolytic therapy. Whether or not the vessel is revascularized is directly related to the patient’s prognosis, and opening the occluded vessel as early as possible is crucial to save the brain tissue. Through the efforts in the past 10 years, interventional treatment of acute ischemic cerebrovascular disease has made great progress. In particular, a variety of transarterial revascularization techniques developed in recent years, including intra-arterial thrombolysis, mechanical thrombus retrieval, and mechanical thrombus fragmentation applied alone or in combination including with intravenous thrombolysis, have led to a much higher rate of revascularization. This can extend the treatment time window and reduce bleeding complications, allowing more patients to benefit from them. In a prospective single-center study reported by Carlos et al, 20 patients with acute ischemic stroke episodes due to occlusion of larger arteries in the anterior intracranial circulation underwent mechanical thrombectomy with the Solitaire AB stent within 8 hours, and 90% of the treated vessels were recanalized after thrombectomy, while 10% of patients had symptomatic postoperative cranial revascularization. of patients develop symptomatic intracranial hemorrhage after the procedure. For these emerging new interventional techniques, large randomized controlled trials are needed to further confirm the safety and efficacy of their clinical application and their ultimate ability to improve patient prognosis and reduce mortality and disability rates. Treatment of intracranial aneurysms Intracranial aneurysm treatment is, as always, a research hotspot in neurointerventional radiology, and transarterial embolization has been the treatment of choice for intracranial aneurysms. The Clinical and Anatomic Outcomes in the Treatment of Ruptured Intracranial Aneurysms (CLARITY) study, published in Radiology 2011, is a prospective, multicenter, consecutive case-group study that directly compared the outcomes of balloon-assisted embolization techniques with conventional spring-ring embolization of ruptured aneurysms for the first time. A total of 768 patients with 768 ruptured aneurysms were embolized in this study, of whom 608 (79.2%) underwent conventional spring-ring embolization and 160 (20.8%) underwent embolization with the balloon-assisted technique. The percentage of aneurysm diameter over 10 mm and aneurysm neck over 4 mm was significantly higher in the balloon-assisted embolization group than in the conventional embolization group. Treatment-related complications (including thromboembolic events, intraoperative aneurysm rupture, and early postoperative rebleeding) and overall mortality did not differ significantly between the two groups, but the rate of aneurysm occlusion was significantly higher in the balloon-assisted embolization technique group (94.9%) than in the conventional spring-ring embolization group (88.7%). Also in 2011, results of a study comparing gel-coated spring coils with platinum spring maps for the treatment of intracranial aneurysms (HELPS) were published in the Lancet. Coated spring coils have been used for the treatment of aneurysms for 8 to 9 years. The use of these biologically active coils is intended to produce a vessel wall repair response and improve embolization, but there has been a lack of strong evidence for their clinical effectiveness. This study was a randomized controlled study of embolization of ruptured or unruptured intracranial aneurysms in 24 centers in 7 countries. 249 patients were treated with coated spring coils. The clinical outcomes (rebleeding and retreatment rates) were not significantly different between the two groups, and the incidence of treatment-related complications was similar, failing to show an advantage of this embolization material. In recent years, neurointerventional radiology has progressed in various fields, and China has the largest group of patients with cerebrovascular diseases in the world. The latest national survey on the causes of death released by the Ministry of Health of China shows that cerebrovascular disease has risen to be the first cause of death among urban and rural residents in China, while cerebrovascular disease is also the first cause of long-term disability. With abundant case resources in China, various new technologies and materials for neurointerventional treatment can be quickly introduced into domestic use and widely carried out, and the safety and effectiveness of their clinical applications are further confirmed. However, there is still a big gap between our ability to independently develop new technologies and materials compared with developed countries, and there are no large-scale multicenter randomized controlled studies on interventional treatment of cerebrovascular diseases, and there is a lack of evidence-based medical evidence on interventional treatment for Chinese people’s own characteristics. Facing a large number of patients, we have the responsibility to explore the most suitable treatment for them and to provide better clinical evidence for the world, which is the responsibility and obligation of Chinese doctors.