Chinese Expert Consensus on Endovascular Treatment Technology for Acute Ischemic Stroke 2025

doi:10.3969/j.issn.1673-5765.2025.11.012

Abstract

Abstract: Endovascular treatment (EVT) has become the first-line treatment for acute ischemic stroke (AIS) caused by intracranial large vessel occlusion. However, there are still many issues regarding the standardized application and individualized selection of EVT, which require further refinement. Therefore, based on the latest advances in EVT clinical studies and expert experience, the Chinese Interventional Neuroradiology Society of Chinese Stroke Association organized an expert working group to systematically review the technical elements of EVT for AIS, including vascular access establishment, device selection and technique application of EVT, thrombectomy strategies for different etiologies, and prevention and management of complications. Using a modified Delphi method, the group formulated graded recommendations (level Ⅰ-Ⅳ), aiming to standardize EVT strategies and techniques, enhance treatment efficiency, and improve patient outcomes.

Key words: Acute ischemic stroke; Endovascular treatment; Technique; Strategy; Expert consensus; Recommendation

摘要： 血管内治疗（endovascular treatment，EVT）已成为颅内大血管闭塞所致急性缺血性卒中（acute ischemic stroke，AIS）的一线治疗方案。但EVT的标准化应用和个体化选择仍存在较多问题，需进一步规范。因此，中国卒中学会神经介入分会组织专家成立了工作组，基于相关临床研究的最新进展并结合专家的临床经验，系统梳理了EVT应用于AIS的技术要点，包括血管通路建立、EVT的器械选择与技术应用、针对不同病因的取栓策略及并发症的预防和处理，采用改良德尔菲法形成Ⅰ～Ⅳ级的分级推荐意见，旨在规范EVT策略与技术、提升治疗效率、改善患者预后。

关键词: 急性缺血性卒中; 血管内治疗; 技术; 策略; 专家共识; 推荐意见

CLC Number:

Chinese Interventional Neuroradiology Society of Chinese Stroke Association. Chinese Expert Consensus on Endovascular Treatment Technology for Acute Ischemic Stroke 2025[J]. Chinese Journal of Stroke, 2025, 20(11): 1428-1459.

中国卒中学会神经介入分会. 急性缺血性卒中血管内治疗技术中国专家共识2025[J]. 中国卒中杂志, 2025, 20(11): 1428-1459.

References

[1] GOYAL M，MENON B K，VAN ZWAM W H，et al. Endovascular thrombectomy after large-vessel ischaemic stroke：a meta-analysis of individual patient data from five randomised trials[J]. Lancet，2016，387（10029）：1723-1731.
[2] 中国卒中学会，《中国卒中学会急性缺血性卒中再灌注治疗指南2024》编写组. 中国卒中学会急性缺血性卒中再灌注治疗指南2024[J]. 中国卒中杂志，2024，19（12）：1460-1478.
Chinese Stroke Association，Writing Group of Chinese Stroke Association Guidelines on Reperfusion
Therapy for Acute Ischemic Stroke 2024. Chinese Stroke Association guidelines on reperfusion therapy for acute ischemic stroke 2024[J]. Chin J Stroke，2024，19（12）：1460-1478.
[3] 中国卒中学会，中国卒中学会神经介入分会，中华预防医学会卒中预防与控制专业委员会介入学组. 急性缺血性卒中血管内治疗中国指南2023[J]. 中国卒中杂志，2023，18（6）：684-711.
Chinese Stroke Association，Chinese Interventional Neuroradiology Society，Intervention Group of Committee of Stroke Prevention and Control of Chinese Preventive Medicine Association. Chinese guideline for endovascular treatment of acute ischemic stroke 2023[J]. Chin J Stroke，2023，18（6）：684-711.
[4] JIA B X，REN Z G，MOKIN M，et al. Current status of endovascular treatment for acute large vessel occlusion in China：a real-world nationwide registry[J]. Stroke，2021，52（4）：1203-1212.
[5] 中国卒中学会神经介入分会. 急性缺血性卒中中等血管闭塞管理中国专家共识2024[J]. 中国卒中杂志，2024，19（11）：1333-1358.
Chinese Interventional Neuroradiology Society of Chinese Stroke Association. Chinese expert consensus on the management of medium vessel occlusion in acute ischemic stroke 2024[J]. Chin J Stroke，2024，19（11）：1333-1358.
[6] CHO H W，JUN H S. Can transradial mechanical thrombectomy be an alternative in case of impossible transfemoral approach for mechanical thrombectomy？A single center’s experience[J]. J Korean Neurosurg Soc，2021，64（1）：60-68.
[7] HAUSSEN D C，NOGUEIRA R G，DESOUSA K G，et al. Transradial access in acute ischemic stroke intervention[J]. J Neurointerv Surg，2016，8（3）：247-250.
[8] PATEL P，HAUSSEN D C，NOGUEIRA R G，et al. The neuro radialist[J]. Interv Cardiol Clin，2020，9（1）：75-86.
[9] MAUD A，KHATRI R，CHAUDHRY M R A，et al. Transradial access results in faster skin puncture to reperfusion time than transfemoral access in posterior circulation mechanical thrombectomy[J]. J Vasc Interv Neurol，2019，10（3）：53-57.
[10] CHEN S H，SNELLING B M，SUR S，et al. Transradial versus transfemoral access for anterior circulation mechanical thrombectomy：comparison of technical and clinical outcomes[J]. J Neurointerv Surg，2019，11（9）：874-878.
[11] SIDDIQUI A H，WAQAS M，NEUMAIER J，et al. Radial first or patient first：a case series and meta-analysis of transradial versus transfemoral access for acute ischemic stroke intervention[J]. J Neurointerv Surg，2021，13（8）：687-692.
[12] VERHEY L H，OROZCO A R，OLIVER M，et al. Transradial versus transfemoral access for mechanical thrombectomy in acute ischemic stroke：a retrospective cohort study[J/OL]. J Stroke Cerebrovasc Dis，2023，32（10）：107282[2025-08-10]. https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107282.
[13] SILVA M A，ELAWADY S S，MAIER I，et al. Comparison between transradial and transfemoral mechanical thrombectomy for ICA and M1 occlusions：insights from the stroke thrombectomy and aneurysm registry（STAR）[J/OL]. J Neurointerv Surg，2024：jnis-2023-021358[2025-08-10]. https://doi.org/10.1136/jnis-2023-021358.
[14] AEMAZ UR REHMAN M，EBAAD UR REHMAN M，REHMAN A U，et al. Efficacy and safety of transradial versus transfemoral access for mechanical thrombectomy in acute ischemic stroke：a systematic review and meta-analysis[J/OL]. Interv Neuroradiol，2025：15910199251342049[2025-08-10]. https://doi.org/10.1177/15910199251342049.
[15] HERNANDEZ D，REQUENA M，OLIVÉ-GADEA M，et al. Radial versus femoral access for mechanical thrombectomy in patients with stroke：a noninferiority randomized clinical trial[J]. Stroke，2024，55（4）：840-848.
[16] YATSKAR L，SELZER F，FEIT F，et al. Access site hematoma requiring blood transfusion predicts mortality in patients undergoing percutaneous coronary intervention：data from the national heart，lung，and blood institute dynamic registry[J]. Catheter Cardiovasc Interv，2007，69（7）：961-966.
[17] 中国医师协会神经介入专业委员会. 神经介入通路建立专家共识[J]. 中国脑血管病杂志，2023，20（7）：493-504，封3.
Chinese Federation of Interventional Clinical Neurosciences. Expert consensus on the establishment of neurointerventional pathway[J]. Chin J Cerebrovasc Dis，2023，20（7）：493-504，inside back cover.
[18] MLEKUSCH W，HAUMER M，MLEKUSCH I，et al. Prediction of iatrogenic pseudoaneurysm after percutaneous endovascular procedures[J]. Radiology，2006，240（2）：597-602.
[19] FRANK J J，KAMALAKANNAN D，KODENCHERY M，et al. Retroperitoneal hematoma in patients undergoing cardiac catheterization[J]. J Interv Cardiol，2010，23（6）：569-574.
[20] ANDÒ G，CAPODANNO D. Radial versus femoral access in invasively managed patients with acute coronary syndrome：a systematic review and meta-analysis[J]. Ann Intern Med，2015，163（12）：932-940.
[21] FERRANTE G，RAO S V，JÜNI P，et al. Radial versus femoral access for coronary interventions across the entire spectrum of patients with coronary artery disease：a meta-analysis of randomized trials[J]. JACC Cardiovasc Interv，2016，9（14）：1419-1434.
[22] STONE J G，ZUSSMAN B M，TONETTI D A，et al. Transradial versus transfemoral approaches for diagnostic cerebral angiography：a prospective，single-center，non-inferiority comparative effectiveness study[J]. J Neurointerv Surg，2020，12（10）：993-998.
[23] KHANNA O，VELAGAPUDI L，DAS S，et al. A comparison of radial versus femoral artery access for acute stroke interventions[J]. J Neurosurg，2020，135（3）：727-732.
[24] ZHOU W J，JIN X，XU C，et al. Trans-radial versus trans-femoral approach for cerebral angiography：a meta-analysis of randomized controlled trials[J]. Wideochir Inne Tech Maloinwazyjne，2023，18（2）：235-243.
[25] SAITO S，IKEI H，HOSOKAWA G，et al. Influence of the ratio between radial artery inner diameter and sheath outer diameter on radial artery flow after transradial coronary intervention[J]. Catheter Cardiovasc Interv，1999，46（2）：173-178.
[26] RASHID M，KWOK C S，PANCHOLY S，et al. Radial artery occlusion after transradial interventions：a systematic review and meta-analysis[J/OL]. J Am Heart Assoc，2016，5：e002686[2025-08-10]. https://doi.org/10.1161/JAHA.115.002686.
[27] VALGIMIGLI M，GAGNOR A，CALABRÓ P，et al. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management：a randomised multicentre trial[J]. Lancet，2015，385（9986）：2465-2476.
[28] BRUNET M C，CHEN S H，SUR S，et al. Distal transradial access in the anatomical snuffbox for diagnostic cerebral angiography[J]. J Neurointerv Surg，2019，11（7）：710-713.
[29] AYYAZ UL HAQ M，RASHID M，GILCHRIST I C，et al. Incidence and clinical course of limb dysfunction post cardiac catheterization—a systematic review[J]. Circ J，2018，82（11）：2736-2744.
[30] TSO M K，RAJAH G B，DOSSANI R H，et al. Learning curves for transradial access versus transfemoral access in diagnostic cerebral angiography：a case series[J]. J Neurointerv Surg，2022，14（2）：174-178.
[31] 中国医师协会神经外科医师分会神经介入专业委员会，中国医师协会介入医师分会神经介入专业委员会，中华医学会神经外科学分会神经介入专业委员会，等. 经桡动脉入路神经介入诊疗中国专家共识[J]. 中华神经外科杂志，2022，38（10）：980-989.
Neurointervention Professional Committee，Neurosurgeon Branch of Chinese Medical Doctor Association；Neurointervention Professional Committee，Interventional Physician Branch of Chinese Medical Doctor Association；Neurointervention Professional Committee，Neurosurgery Branch of Chinese Medical Association；et al. Chinese expert consensus on neurointerventional diagnosis and treatment via transradial approach[J]. Chin J Neurosurg，2022，38（10）：980-989.
[32] IANCU A，TUDOR R，CHITA D S，et al. Mechanical thrombectomy via transbrachial approach in the emergency management of acute ischemic stroke patients with aortic pathologies：our experience and literature review[J/OL]. J Pers Med，2024，14（2）：216[2025-08-10]. https://doi.org/10.3390/jpm14020216.
[33] KENNEDY A M，GROCOTT M，SCHWARTZ M S，et al. Median nerve injury：an underrecognised complication of brachial artery cardiac catheterisation？[J]. J Neurol Neurosurg Psychiatry，1997，63（4）：542-546.
[34] SCOCO A N，ADDEPALLI A，ZHU S Y，et al. Trans-carotid and trans-radial access for mechanical thrombectomy for acute ischemic stroke：a systematic review and meta-analysis[J/OL]. Cureus，2020，12（6）：e8875[2025-08-10]. https://doi.org/10.7759/cureus.8875.
[35] ZHONG A J，KAMAL H，UDDIN A，et al. Transcarotid access for mechanical thrombectomy in acute ischemic stroke：a meta-analysis and systematic review[J/OL]. J Stroke Cerebrovasc Dis，2022，31（5）：106428[2025-08-10]. https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106428.
[36] JADHAV A P，RIBO M，GRANDHI R，et al. Transcervical access in acute ischemic stroke[J]. J Neurointerv Surg，2014，6（9）：652-657.
[37] WIESMANN M，KALDER J，REICH A，et al. Feasibility of combined surgical and endovascular carotid access for interventional treatment of ischemic stroke[J]. J Neurointerv Surg，2016，8（6）：571-575.
[38] ROCHE A D，MURPHY B，ADAMS N，et al. Direct common carotid artery puncture for endovascular treatment of acute large vessel ischemic stroke in a patient with aortic coarctation[J/OL]. J Stroke Cerebrovasc Dis，2017，26（11）：e211-e213[2025-08-10]. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.07.017.
[39] DESAI J A，ALMEKHLAFI M A，HILL M D，et al. Ultrasound guided V3 segment vertebral artery direct percutaneous puncture for basilar artery mechanical thrombectomy in acute stroke：a technical report[J/OL]. J Neurointerv Surg，2014，6（3）：e18[2025-08-10]. https://doi.org/10.1136/neurintsurg-2012-010601.rep.
[40] KHANNA O，MOUCHTOURIS N，SWEID A，et al. Transradial approach for acute stroke intervention：technical procedure and clinical outcomes[J/OL]. Stroke Vasc Neurol，2020，5：e000263[2025-08-10]. https://doi.org/10.1136/svn-2019-000263.
[41] GUO X，WANG L F，LIU J L，et al. Transradial approach using a distal access catheter without guiding support for symptomatic intracranial vertebral artery and basilar artery stenosis：a multicenter experience and technical procedure[J/OL]. J Neurointerv Surg，2022，14（5）：neurintsurg-2021-017635[2025-08-10]. https://doi.org/10.1136/neurintsurg-2021-017635.
[42] BOEKEN T，ALTAYEB A，SHOTAR E，et al. Prohibitive radial artery occlusion rates following transradial access using a 6-French neuron max long sheath for intracranial aneurysm treatment[J]. Clin Neuroradiol，2022，32（4）：1031-1036.
[43] SMITH W S，SUNG G，STARKMAN S，et al. Safety and efficacy of mechanical embolectomy in acute ischemic stroke：results of the MERCI trial[J]. Stroke，2005，36（7）：1432-1438.
[44] SMITH W S，SUNG G，SAVER J，et al. Mechanical thrombectomy for acute ischemic stroke：final results of the multi MERCI trial[J]. Stroke，2008，39（4）：1205-1212.
[45] ALSHEKHLEE A，PANDYA D J，ENGLISH J，et al. Merci mechanical thrombectomy retriever for acute ischemic stroke therapy：literature review[J/OL]. Neurology，2012，79（13 Suppl 1）：S126-S134[2025-08-10]. https://doi.org/10.1212/WNL.0b013e3182697e89.
[46] SAVER J L，JAHAN R，LEVY E I，et al. Solitaire flow restoration device versus the Merci retriever in patients with acute ischaemic stroke（SWIFT）：a randomised，parallel-group，non-inferiority trial[J]. Lancet，2012，380（9849）：1241-1249.
[47] NOGUEIRA R G，LUTSEP H L，GUPTA R，et al. Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke（TREVO 2）：a randomised trial[J]. Lancet，2012，380（9849）：1231-1240.
[48] AUTAR A S A，HUND H M，RAMLAL S A，et al. High-resolution imaging of interaction between thrombus and stent-retriever in patients with acute ischemic stroke[J/OL]. J Am Heart Assoc，2018，7（13）：e008563[2025-08-10]. https://doi.org/10.1161/JAHA.118.008563.
[49] GERSH K C，NAGASWAMI C，WEISEL J W. Fibrin network structure and clot mechanical properties are altered by incorporation of erythrocytes[J]. Thromb Haemost，2009，102（6）：1169-1175.
[50] BELACHEW N F，DOBROCKY T，MEINEL T R，et al. Risks of undersizing stent retriever length relative to thrombus length in patients with acute ischemic stroke[J]. AJNR Am J Neuroradiol，2021，42（12）：2181-2187.
[51] KIM J H，KIM B M，KIM D J. In vitro analysis of the efficacy of endovascular thrombectomy techniques according to the vascular tortuosity using 3D printed models[J]. AJNR Am J Neuroradiol，2022，43（10）：1431-1436.
[52] Penumbra Pivotal Stroke Trial Investigators. The Penumbra pivotal stroke trial：safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease[J]. Stroke，2009，40（8）：2761-2768.
[53] TURK A S，SPIOTTA A，FREI D，et al. Initial clinical experience with the ADAPT technique：a direct aspiration first pass technique for stroke thrombectomy[J]. J Neurointerv Surg，2014，6（3）：231-237.
[54] LAPERGUE B，BLANC R，GORY B，et al. Effect of endovascular contact aspiration vs. stent retriever on revascularization in patients with acute ischemic stroke and large vessel occlusion：the ASTER randomized clinical trial[J]. JAMA，2017，318（5）：443-452.
[55] TURK A S，3rd，SIDDIQUI A，FIFI J T，et al. Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion（COMPASS）：a multicentre，randomised，open label，blinded outcome，non-inferiority trial[J]. Lancet，2019，393（10175）：998-1008.
[56] POWERS W J，RABINSTEIN A A，ACKERSON T，et al. Guidelines for the early management of patients with acute ischemic stroke：2019 update to the 2018 guidelines for the early management of acute ischemic stroke：a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J/OL]. Stroke，2019，50（12）：e344-e418[2025-08-10]. https://doi.org/10.1161/STR.0000000000000211.
[57] YE G F，WEN X B，WANG H C，et al. First-line contact aspiration versus first-line stent retriever for acute posterior circulation strokes：an updated meta-analysis[J/OL]. J Neurointerv Surg，2022，14（5）：neurintsurg-2021-017497[2025-08-10]. https://doi.org/10.1136/neurintsurg-2021-017497.
[58] GUO X M，XIONG Y，HUANG X Y，et al. Aspiration versus stent retriever for posterior circulation stroke：a meta-analysis[J]. CNS Neurosci Ther，2023，29（2）：525-537.
[59] YE G F，LU J，QI P，et al. Firstline a direct aspiration first pass technique versus firstline stent retriever for acute basilar artery occlusion：a systematic review and meta-analysis[J]. J Neurointerv Surg，2019，11（8）：740-746.
[60] XENOS D，TEXAKALIDIS P，KARRAS C L，et al. First-line stent retriever versus direct aspiration for acute basilar artery occlusions：a systematic review and meta-analysis[J/OL]. World Neurosurg，2022，158：258-267[2025-08-10]. https://doi.org/10.1016/j.wneu.2021.11.013.
[61] SPIOTTA A M，CHAUDRY M I，HUI F K，et al. Evolution of thrombectomy approaches and devices for acute stroke：a technical review[J]. J Neurointerv Surg，2015，7（1）：2-7.
[62] 赵亚鸽，肖国栋. 直接抽吸首次通过技术用于急性缺血性卒中的研究进展[J]. 临床内科杂志，2024，41（5）：302-306.
ZHAO Y G，XIAO G D. Research progress on direct aspiration first-pass technique for acute ischemic stroke[J]. J Clin Intern Med，2024，41（5）：302-306.
[63] BLANC R，REDJEM H，CICCIO G，et al. Predictors of the aspiration component success of a direct aspiration first pass technique（ADAPT）for the endovascular treatment of stroke reperfusion strategy in anterior circulation acute stroke[J]. Stroke，2017，48（6）：1588-1593.
[64] KIM S，LEE J Y. Comparison of vacuum pressures and suction forces generated by different pump systems for aspiration thrombectomy[J/OL]. Front Neurol，2022，13：978584[2025-08-10]. https://doi.org/10.3389/fneur.2022.978584.
[65] GROSS B A，JADHAV A P，JOVIN T G，et al. Dump the pump：manual aspiration thrombectomy（MAT）with a syringe is technically effective，expeditious，and cost-efficient[J]. J Neurointerv Surg，2018，10（4）：354-357.
[66] SIMON S，GREY C P，MASSENZO T，et al. Exploring the efficacy of cyclic vs. static aspiration in a cerebral thrombectomy model：an initial proof of concept study[J]. J Neurointerv Surg，2014，6（9）：677-683.
[67] BERNAVA G，ROSI A，BOTO J，et al. Experimental evaluation of direct thromboaspiration efficacy according to the angle of interaction between the aspiration catheter and the clot[J]. J Neurointerv Surg，2021，13（12）：1152-1156.
[68] MATSUMOTO H，NISHIYAMA H，TETSUO Y，et al. Initial clinical experience using the two-stage aspiration technique（TSAT）with proximal flow arrest by a balloon guiding catheter for acute ischemic stroke of the anterior circulation[J]. J Neurointerv Surg，2017，9（12）：1160-1165.
[69] HEIT J J，WONG J H，MOFAFF A M，et al. Sofia intermediate catheter and the SNAKE technique：safety and efficacy of the Sofia catheter without guidewire or microcatheter construct[J]. J Neurointerv Surg，2018，10（4）：401-406.
[70] GRIEB D，GRELING B，SCHULZ K，et al. Endovascular treatment of distal medium vessel occlusions using microcatheter aspiration thrombectomy[J]. Interv Neuroradiol，2024，30（2）：234-241.
[71] CONCHING A，CLAUSEN T M，NAKAMURA R，et al. Initial experience with ultra-large-bore catheter aspiration for very large vessel occlusions[J/OL]. Interv Neuroradiol，2025：15910199251343666[2025-08-10]. https://doi.org/10.1177/15910199251343666.
[72] JAZAYERI S B，REDA A，CORTESE J，et al. Impact of aspiration catheter inner diameter on first-pass effect：a systematic review and meta-analysis[J/OL]. Interv Neuroradiol，2025：15910199251345637[2025-08-10]. https://doi.org/10.1177/15910199251345637.
[73] GANDHI D，CHEN H，ZAIDI S，et al. SOFIA aspiration system as first-line technique（SOFAST）：a prospective，multicenter study to assess the efficacy and safety of the 6 French SOFIA flow plus aspiration catheter for endovascular stroke thrombectomy[J]. J Neurointerv Surg，2025，17（7）：753-758.
[74] NOGUEIRA R G，MOHAMMADEN M H，AL-BAYATI A R，et al. Preliminary experience with 088 large bore intracranial catheters during stroke thrombectomy[J]. Interv Neuroradiol，2021，27（3）：427-433.
[75] CALDWELL J，MCGUINNESS B，LEE S S，et al. Aspiration thrombectomy using a novel 088 catheter and specialized delivery catheter[J]. J Neurointerv Surg，2022，14（12）：1239-1243.
[76] LEE J S，HONG J M，LEE S J，et al. The combined use of mechanical thrombectomy devices is feasible for treating acute carotid terminus occlusion[J]. Acta Neurochir（Wien），2013，155（4）：635-641.
[77] HUMPHRIES W，HOIT D，DOSS V T，et al. Distal aspiration with retrievable stent assisted thrombectomy for the treatment of acute ischemic stroke[J]. J Neurointerv Surg，2015，7（2）：90-94.
[78] JABLONSKA M，LI J H，TIBERI R，et al. Partial（SAVE）versus complete（Solumbra）stent retriever retraction technique for mechanical thrombectomy：a randomized in vitro study[J]. AJNR Am J Neuroradiol，2023，44（10）：1165-1170.
[79] YI H J，SUNG J H，LEE D H，et al. Effectiveness and technical considerations of solitaire platinum 4×40 mm
stent retriever in mechanical thrombectomy with solumbra technique[J]. J Korean Neurosurg Soc，2021，64（1）：30-38.
[80] MASSARI F，HENNINGER N，LOZANO J D，et al. ARTS（aspiration-retriever technique for stroke）：initial clinical experience[J]. Interv Neuroradiol，2016，22（3）：325-332.
[81] MAUS V，BEHME D，KABBASCH C，et al. Maximizing first-pass complete reperfusion with SAVE[J]. Clin Neuroradiol，2018，28（3）：327-338.
[82] CHEN L W，SHEN R，ZHANG X，et al. A single-center comparative study of the SWIM technique in the treatment of acute ischemic stroke due to anterior circulation occlusion[J/OL]. Thromb Res，2020，192：131-133[2025-08-15]. https://doi.org/10.1016/j.thromres.2020.05.011.
[83] GURKAS E，AKPINAR C K，AYTAC E. ADVANCE：an effective and feasible technique in acute stroke treatment[J]. Interv Neuroradiol，2017，23（2）：166-172.
[84] HOPF-JENSEN S，PREIß M，MARQUES L，et al. Impact and effectiveness of dual aspiration technique in stent-assisted mechanical thrombectomy：recent improvements in acute stroke management[J]. Cardiovasc Intervent Radiol，2016，39（11）：1620-1628.
[85] NIKOUBASHMAN O，ALT J P，NIKOUBASHMAN A，et al. Optimizing endovascular stroke treatment：removing the microcatheter before clot retrieval with stent-retrievers increases aspiration flow[J]. J Neurointerv Surg，2017，9（5）：459-462.
[86] WEI M，WEI Z Q，LI X，et al. Retrograde semi-retrieval technique for combined stentriever plus aspiration thrombectomy in acute ischemic stroke[J]. Interv Neuroradiol，2017，23（3）：285-288.
[87] LAPERGUE B，BLANC R，COSTALAT V，et al. Effect of thrombectomy with combined contact aspiration and stent retriever vs. stent retriever alone on revascularization in patients with acute ischemic stroke and large vessel occlusion：the ASTER2 randomized clinical trial[J]. JAMA，2021，326（12）：1158-1169.
[88] OSPEL J M，VOLNY O，JAYARAMAN M，et al. Optimizing fast first pass complete reperfusion in acute ischemic stroke-the BADDASS approach（balloon guide with large bore distal access catheter with dual aspiration with stent-retriever as standard approach）[J]. Expert Rev Med Devices，2019，16（11）：955-963.
[89] CHEN W H，YI T Y，WU Y M，et al. Initial clinical experience of repeat thrombectomy with a retrieval stent（RTRS）with continuous proximal flow arrest by balloon guide catheter for acute intracranial carotid occlusion[J/OL]. Behav Neurol，2021：7607324[2025-08-15]. https://doi.org/10.1155/2021/7607324.
[90] LIU J M，ZHOU Y，ZHANG L，et al. Balloon guide catheters for endovascular thrombectomy in patients with acute ischaemic stroke due to large-vessel occlusion in China（PROTECT-MT）：a multicentre，open-label，blinded-endpoint，randomised controlled trial[J]. Lancet，2024，404（10468）：2165-2174.
[91] GOYAL M，OSPEL J M，GANESH A，et al. Endovascular treatment of stroke due to medium-vessel occlusion[J]. N Engl J Med，2025，392（14）：1385-1395.
[92] PSYCHOGIOS M，BREHM A，RIBO M，et al. Endovascular treatment for stroke due to occlusion of medium or distal vessels[J]. N Engl J Med，2025，392（14）：1374-1384.
[93] HAUSSEN D C，AL-BAYATI A R，EBY B，et al. Blind exchange with mini-pinning technique for distal occlusion thrombectomy[J]. J Neurointerv Surg，2020，12（4）：392-395.
[94] PSYCHOGIOS M N，TSOGKAS I，BLACKHAM K，et al. The Quattro technique for medium distal vessel occlusion stroke[J]. Clin Neuroradiol，2024，34（1）：257-262.
[95] NIKOUBASHMAN O，DEKEYZER S，RIABIKIN A，et al. True first-pass effect[J]. Stroke，2019，50（8）：2140-2146.
[96] GUTIERREZ J，TURAN T N，HOH B L，et al. Intracranial atherosclerotic stenosis：risk factors，diagnosis，and treatment[J]. Lancet Neurol，2022，21（4）：355-368.
[97] WANG Y J，ZHAO X Q，LIU L P，et al. Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China：the Chinese intracranial atherosclerosis（CICAS）study[J]. Stroke，2014，45（3）：663-669.
[98] TSANG A C O，ORRU E，KLOSTRANEC J M，et al. Thrombectomy outcomes of intracranial atherosclerosis-related occlusions[J]. Stroke，2019，50（6）：1460-1466.
[99] LEE J S，HONG J M，LEE K S，et al. Endovascular therapy of cerebral arterial occlusions：intracranial atherosclerosis versus embolism[J]. J Stroke Cerebrovasc Dis，2015，24（9）：2074-2080.
[100] PSYCHOGIOS M，BREHM A，LÓPEZ-CANCIO E，et al. European Stroke Organisation guidelines on treatment of patients with intracranial atherosclerotic disease[J]. Eur Stroke J，2022，7（3）：3-4.
[101] YI T Y，CHEN W H，WU Y M，et al. Microcatheter“first-pass effect”predicts acute intracranial artery atherosclerotic disease-related occlusion[J]. Neurosurgery，2019，84（6）：1296-1305.
[102] CHEN W H，YI T Y，ZHAN A L，et al. Stent-unsheathed effect predicts acute distal middle cerebral artery atherosclerotic disease-related occlusion[J/OL]. J Neurol Sci，2020，416：116957[2025-08-15]. https://doi.org/10.1016/j.jns.2020.116957.
[103] KANG D H，YOON W，BAEK B H，et al. Front-line thrombectomy for acute large-vessel occlusion with underlying severe intracranial stenosis：stent retriever versus contact aspiration[J]. J Neurosurg，2020，132（4）：1202-1208.
[104] TONG X，WANG Y L，BAUER C T，et al. Current status of aspiration thrombectomy for acute stroke patients in China：data from ANGEL-ACT registry[J/OL]. Ther Adv Neurol Disord，2021，14：17562864211007715[2025-08-15]. https://doi.org/10.1177/17562864211007715.
[105] MOHAMMADEN M H，HAUSSEN D C，AL-BAYATI A R，et al. Stenting and angioplasty in neurothrombectomy：matched analysis of rescue intracranial stenting versus failed thrombectomy[J]. Stroke，2022，53（9）：2779-2788.
[106] JIA B X，ZHANG L H，PAN Y S，et al. Rescue angioplasty and/or stenting after mechanical thrombectomy：who can benefit？[J]. J Neurointerv Surg，2024，16（12）：1360-1367.
[107] AL KASAB S，ALMALLOUHI E，JUMAA M，et al. Outcomes of adjunct emergent stenting versus mechanical thrombectomy alone：the RESCUE-ICAS registry[J]. Stroke，2025，56（2）：390-400.
[108] GAO F，TONG X，JIA B X，et al. Bailout intracranial angioplasty or stenting following thrombectomy for acute large vessel occlusion in China（ANGEL-REBOOT）：a multicentre，open-label，blinded-endpoint，randomised controlled trial[J]. Lancet Neurol，2024，23（8）：797-806.
[109] GAO F，TONG X，WEI M，et al. Bailout intracranial angioplasty or stenting after thrombectomy for acute large vessel occlusion：1-year outcomes of ANGEL-REBOOT[J]. Circulation, 2025，152（20）：1397-1407.
[110] DENG Y M，YAO Y C，TONG X，et al. Necessity and timing of angioplasty in acute large-vessel occlusion strokes due to intracranial atherosclerotic disease：a cohort analysis with data from the ANGEL-ACT registry[J/OL]. Front Neurol，2023，14：1087816[2025-08-15]. https://doi.org/10.3389/fneur.2023.1087816.
[111] SANG H F，XIE D J，TIAN Y，et al. Association of tirofiban with functional outcomes after thrombectomy in acute ischemic stroke due to intracranial atherosclerotic disease[J/OL]. Neurology，2023，100（19）：e1996-e2006[2025-08-15]. https://doi.org/10.1212/WNL.0000000000207194.
[112] RIBEIRO L F S，DE FREITAS L R，UDOMA-UDOFA O C，et al. Efficacy and safety of tirofiban in acute ischemic stroke due to intracranial atherosclerotic disease for patients undergoing endovascular treatment：a systematic review and meta-analysis[J]. Neuroradiology，2025，67（1）：241-255.
[113] GONÇALVES O R，MARINHO MENDES FILHO F S，RIBEIRO F V，et al. Efficacy and safety of intravenous tirofiban in patients with acute ischemic stroke due to large artery atherosclerosis undergoing endovascular thrombectomy：a systematic review and meta-analysis[J/OL]. Clin Neurol Neurosurg，2025，249：108727[2025-08-15]. https://doi.org/10.1016/j.clineuro.2025.108727.
[114] BURKHARDT J K，SHAPIRO M，TANWEER O，et al. Balloon-assisted tracking technique to overcome intracranial stenosis during thrombectomy for stroke[J/OL]. J Neurointerv Surg，2019，11（3）：e1[2025-08-15]. https://doi.org/10.1136/neurintsurg-2018-014275.rep.
[115] YI T Y，WU Y M，LIN D L，et al. Application of balloon angioplasty with the distal protection of stent retriever（BASIS）technique for acute intracranial artery atherosclerosis-related occlusion[J/OL]. Front Neurol，2022，13：1049543[2025-08-15]. https://doi.org/10.3389/fneur.2022.1049543.
[116] YI T Y，GAN S J，CHEN Z T，et al. Application of balloon-expandable stent angioplasty with distal support of the stent-retriever（BASIS-STENT）technique for acute intracranial artery atherosclerosis-related occlusion[J/OL]. J Neurointerv Surg，2025：jnis-2024-022862[2025-08-15]. https://doi.org/10.1136/jnis-2024-022862.
[117] HART R G. Cardiogenic embolism to the brain[J]. Lancet，1992，339（8793）：589-594.
[118] DARCOURT J，WITHAYASUK P，VUKASINOVIC I，et al. Predictive value of susceptibility vessel sign for arterial recanalization and clinical improvement in ischemic stroke[J]. Stroke，2019，50（2）：512-515.
[119] 朱国，吴达，周志平，等. 抽吸取栓术与支架取栓术治疗前循环心源性脑栓塞患者的安全性和有效性分析[J]. 中国脑血管病杂志，2022，19（12）：817-823，853.
ZHU G，WU D，ZHOU Z P，et al. Safety and efficacy of a direct aspiration first-pass thrombectomy technology versus stent-retriever thrombectomy for patients with anterior circulation cardiogenic cerebral embolism[J]. Chin J Cerebrovasc Dis，2022，19（12）：817-823，853.
[120] BOURCIER R，MARNAT G，DARGAZANLI C，et al. Safety and efficacy of stent retrievers plus contact aspiration in patients with acute ischaemic anterior circulation stroke and positive susceptibility vessel sign in France（VECTOR）：a randomised，single-blind trial[J]. Lancet Neurol，2024，23（7）：700-711.
[121] GERBER J C，DAUBNER D，KAISER D，et al. Efficacy and safety of direct aspiration first pass technique versus stent-retriever thrombectomy in acute basilar artery occlusion—a retrospective single center experience[J]. Neuroradiology，2017，59（3）：297-304.
[122] TOMASELLO A，MOREU M，TERCEÑO M，et al. Randomized study comparing first-line dual versus single-stent retriever technique：TWIN2WIN[J]. Stroke，2025，56（2）：326-334.
[123] POPPE A Y，JACQUIN G，ROY D，et al. Tandem carotid lesions in acute ischemic stroke：mechanisms，therapeutic challenges，and future directions[J]. AJNR Am J Neuroradiol，2020，41（7）：1142-1148.
[124] WEINBERG J H，SWEID A，SAJJA K，et al. Posterior circulation tandem occlusions：classification and techniques[J/OL]. Clin Neurol Neurosurg，2020，198：106154[2025-08-15]. https://doi.org/10.1016/j.clineuro.2020.106154.
[125] ANADANI M，MARNAT G，CONSOLI A，et al. Endovascular therapy of anterior circulation tandem occlusions：pooled analysis from the TITAN and ETIS registries[J]. Stroke，2021，52（10）：
3097-3105.
[126] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国头颈部动脉夹层诊治指南2024[J]. 中华神经科杂志，2024，57（8）：813-829.
Chinese Society of Neurology，Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of cervicocranial artery dissection 2024[J]. Chin J Neurol，2024，57（8）：813-829.
[127] PAPANAGIOTOU P，HAUSSEN D C，TURJMAN F，et al. Carotid stenting with antithrombotic agents and intracranial thrombectomy leads to the highest recanalization rate in patients with acute stroke with tandem lesions[J]. JACC Cardiovasc Interv，2018，11（13）：1290-1299.
[128] 张汤钦，陈楚，黄显军，等. 前循环串联病变研究进展[J]. 中华神经科杂志，2021，54（3）：284-289.
ZHANG T Q，CHEN C，HUANG X J，et al. Research progress of anterior circulation tandem lesions[J]. Chin J Neurol，2021，54（3）：284-289.
[129] MAUS V，BEHME D，MAURER C，et al. The ReWiSed CARe technique：simultaneous treatment of atherosclerotic tandem occlusions in acute ischemic stroke[J]. Clin Neuroradiol，2020，30（3）：489-494.
[130] LEE S H，LEE D G，KWON S U，et al. Relay-balloon technique for recanalization of acute symptomatic proximal internal carotid artery occlusion with short balloon-tipped guiding catheter landing zone[J]. J Neurointerv Surg，2018，10（1）：39-43.
[131] 孙洪扬，王贤军，王浩，等. 恢复灌注-球囊扩张-机械取栓-支架成形技术在颈动脉串联病变中的应用[J]. 中华神经科杂志，2022，55（1）：35-40.
SUN H Y，WANG X J，WANG H，et al. Application of reperfusion-expanding-thrombectomy-stenting technique in carotid tandem lesions[J]. Chin J Neurol，2022，55（1）：35-40.
[132] CHEN W H，YI T Y，WU Y M，et al. Endovascular therapy strategy for acute embolic tandem occlusion：the pass-thrombectomy-protective thrombectomy（Double PT）technique[J/OL]. World Neurosurg，2018，120：e421-e427[2025-08-15]. https://doi.org/10.1016/j.wneu.2018.08.096.
[133] YI T Y，CHEN W H，WU Y M，et al. Another endovascular therapy strategy for acute tandem occlusion：protect-expand-aspiration-revascularization-stent（PEARS）technique[J/OL]. World Neurosurg，2018，113：e431-e438[2025-08-15]. https://doi.org/10.1016/j.wneu.2018.02.052.
[134] SULTAN-QURRAIE A，WITT T，DE HAVENON A，et al. SEIMLESS：simultaneous extracranial，intracranial management of（tandem）lesions in stroke[J]. J Neurointerv Surg，2019，11（9）：879-883.
[135] DIANA F，ROMOLI M，TOCCACELI G，et al. Emergent carotid stenting versus no stenting for acute ischemic stroke due to tandem occlusion：a meta-analysis[J]. J Neurointerv Surg，2023，15（5）：428-432.
[136] ZHU F，BRACARD S，ANXIONNAT R，et al. Impact of emergent cervical carotid stenting in tandem occlusion strokes treated by thrombectomy：a review of the TITAN collaboration[J/OL]. Front Neurol，2019，10：206[2025-08-15]. https://doi.org/10.3389/fneur.2019.00206.
[137] XING P F，ZHANG Y W，LI Z F，et al. The“distal-to-proximal”strategy for the treatment of posterior circulation tandem occlusions：a single-centre experience[J]. Neuroradiology，2020，62（7）：867-876.
[138] BAIK S H，JUNG C，KIM B M，et al. Mechanical thrombectomy for tandem vertebrobasilar stroke：characteristics and treatment outcome[J]. Stroke，2020，51（6）：1883-1885.