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Objective To analyze the causes and possible influence factors of endovascular recanalization failure of chronic internal carotid artery occlusion (CICAO). Methods One hundred and three patients with CICAO underwent endovascular recanalization in Department of Interventional Neurology in Beijing Tiantan Hospital, Capital Medical University were selected from December 2012 to December 2019. The factors possibly related to failure (including sex, age, underlying disease, time from occlusionto recanalization, the shape of the stump and the position of the reflux) were analyzed. Univariate and multivariate Logistic regression analysis were used to screen for influence factors related to the failure of recanalization. Results In 103cases,there were33 patients who failed in recanalization, the failurerate was 32.04%. One case (0.97%) occurred subarachnoid hemorrhage which induced severe headache during operation. Logistic regression analysis showed thatthe stump ofthe occluded ICA was non⁃pointed (OR= 3.037, 95%CI: 1.245-7.406; P=0.015) and the reflux position of the distal ICA was above the cavernous sinus (C4-C6 segment; OR =3.118, 95%CI: 1.206-8.061, P =0.019) were the risk factors for failure of successful rate after endovascular recanalization of CICAO. Of the 33 failure cases, 27 cases (81.82%) were due to guide wires failed to pass through the occlusion segment, which mainly occurred in C4-C5 segment (14 cases, 42.42%) and C1 segment (11 cases, 33.33%); other 6 cases (18.18%) were due to dissection which mainly occurred in C4-C5 segment (5 cases, 15.15%). Conclusions Endovascular recanalization of CICAO is relatively safe and feasible. The stump condition and the position of distal reflux of the occlud ed ICA are the key in judging the difficulty of recanalization. DOI：10.3969/j.issn.1672⁃6731.2020.06.005

Acute progressive large vessel occlusive stroke (APLVO) is a special kind of acute ischemic stroke with large vessel occlusion (AIS⁃LVO). Adequate medical history inquiry, detailed imaging analysis and appropriate individualized treatment can lead to better therapeutic effect for APLVO patients. This article reviews the pathophysiological mechanism, clinical features, classification and treatment strategy of APLVO, which different from other causes of ischemic stroke. DOI：10.3969/j.issn.1672⁃6731.2020.05.004

Objective To evaluate whether patients with acute basilar artery occlusion (BAO) tandem lesion could affect the clinical outcome after receiving endovascular treatment (EVT) in a high ⁃ volume stroke center. Methods A total of 187 consecutive patients with acute BAO receiving EVT from January 2012 to July 2018 were recruited in this study. The patients were categorized into 2 groups with (25 cases) or without (162 cases) tandem lesion. Preoperative Posterior Circulation Alberta Stroke Program Early CT Score (pc ⁃ ASPECTS) and Pons ⁃ Midbrairn Index (PMI) were used to evaluate the cerebral infarction range, and Post ⁃ Traffic Score and American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grading were used to evaluate the posterior circulation collateral compensation after actue BAO. The main prognostic indicators were immediate postoperative vascular recanalization rate, functional independence and prognosis 90 d after treatment, and the main safety endpoints were intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH) incidence 7 d after surgery and mortality 90 d after treatment. Results In tandem group, the lesions were mainly located at the beginning of the basilar artery (including the intracranial segment of the vertebral artery) and at the distal end ( P = 0.000), and the proportion of intracranial arterial stenosis was lower ( P = 0.000). Among the 25 patients with tandem lesion, 21 took the Dirty ⁃ road route and 4 took the Clean ⁃ road route. The proportion of stent thrombectomy ( P = 0.030) and intraoperative intravenous injection of tirofibana ( P = 0.028) was lower, the proportion of stent implantation was higher ( P = 0.005), the proportion of vascular recanalization after treatment was lower ( P = 0.001), and the mortality rate was higher 90 d after treatment ( P = 0.002). Univariate and multivariate Logistic regression analysis showed that acute BAO tandem lesion had a lower immediate vascular recanalization rate ( OR = 0.050, 95% CI: 0.010-0.530; P = 0.012) and a higher mortality 90 d after treatment (OR = 17.320, 95% CI: 2.700-111.040; P = 0.003). Conclusions Tandem lesion seems to be associated with low rate of recanalization and high rate of mortality in patients with acute BAO. DOI：10.3969/j.issn.1672⁃6731.2020.05.005

The diagnosis and treatment of chronic large vessel occlusion is in its infancy period. At present, few studies reported some successful cases, but on the whole, the opening of large vessel occlusion is in a state of exploration in terms of preoperative evaluation, patient selection, technical methods and also evidence⁃based medicine. With improvement of the experience of multi⁃disciplinary doctors, as well as the updating and iteration of nerve⁃interventional materials, the level of diagnosis and treatment of large vessel occlusion is constantly improving. We focus on the current situation and problems of endovascular treatment of chronic macrovascular occlusion in order to provide valuable experience for the future development of this work. DOI: 10.3969/j.issn.1672⁃6731.2020.06.002

DOI：10.3969/j.issn.1672⁃6731.2020.06.001

China faces the greatest challenge from stroke in the world. The death rate for cerebrovascular diseases in China was 149.49 per 100 000, accounting for 1.57 million deaths in 2018. It ranked third among the leading causes of death behind malignant tumours and heart disease. The age-standardised prevalence and incidence of stroke in 2013 were 1114.8 per 100 000 population and 246.8 per 100 000 person-years, respectively. According to the Global Burden of Disease Study 2017, the years of life lost (YLLs) per 100 000 population for stroke increased by 14.6%; YLLs due to stroke rose from third highest among all causes in 1990 to the highest in 2017. The absolute numbers and rates per 100 000 population for all-age disability-adjusted life years (DALYs) for stroke increased substantially between 1990 and 2017, and stroke was the leading cause of all-age DALYs in 2017. The main contributors to cerebrovascular diseases include behavioural risk factors (smoking and alcohol use) and pre-existing conditions (hypertension, diabetes mellitus, dyslipidaemia and atrial fibrillation (AF)). The most prevalent risk factors among stroke survivors were hypertension (63.0%-84.2%) and smoking (31.7%-47.6%). The least prevalent was AF (2.7%-7.4%). The prevalences for major risk factors for stroke are high and most have increased over time. Based on the latest national epidemiological data, 26.6% of adults aged ≥15 years (307.6 million adults) smoked tobacco products. For those aged ≥18 years, age-adjusted prevalence of hypertension was 25.2%; adjusted prevalence of hypercholesterolaemia was 5.8%; and the standardised prevalence of diabetes was 10.9%. For those aged ≥40 years, the standardised prevalence of AF was 2.31%. Data from the Hospital Quality Monitoring System showed that 3 010 204 inpatients with stroke were admitted to 1853 tertiary care hospitals during 2018. Of those, 2 466 785 (81.9%) were ischaemic strokes (ISs); 447 609 (14.9%) were intracerebral haemorrhages (ICHs); and 95 810 (3.2%) were subarachnoid haemorrhages (SAHs). The average age of patients admitted was 66 years old, and nearly 60% were male. A total of 1555 (0.1%), 2774 (0.6%) and 1347 (1.4%) paediatric strokes (age