| Objective and significance Stroke is the leading cause of death and disability in adults in China.Ischemic stroke is the most common type of stroke,and the incidence of ischemic stroke is increasing worldwide in the recent decade.Intracranial artery stenosis is the most common cause of ischemic stroke,but the optimal anesthetic strategy for such patients is less frequently reported.Whether anaesthetic decision-making(general or regional anaesthesia)affects perioperative safety and outcomes in patients undergoing interventional surgery for ischaemic cerebrovascular disease is still missing clinical evidence.Hypotension,as a potential cause of injury in patients with ischemic cerebrovascular disease,deserves higher attention in the clinic.Sedation with high-dose propofol is associated with hypotension and may be harmful in patients with ischemic cerebrovascular disease,therefore,drug selection and dosage need to be reevaluated and scrutinized.Early studies have shown that remimazolam can be used for the induction and maintenance of general anesthesia and that hypotension occurs less frequently than propofol.Therefore,further evaluation of the use of remimazolam in general anesthesia of patients with ischemic cerebrovascular disease is needed.In this study,by observing the effect of general anesthesia versus local anesthesia in perioperative safety and prognosis of patients undergoing interventional surgery for ischemic cerebrovascular disease,to explore the optimal anesthesia decision for ICAS patients and to analyze the influencing factors affecting the perioperative safety and prognosis of patients.To investigate the clinical application of remimazolam plus propofol on the perioperative hemodynamic indexes,perioperative neurocognitive function,and clinical outcomes of patients undergoing interventional surgery for ICAS in a vulnerable population with cerebral function(ischemic cerebrovascular disease).Methods Part 1: Effects of general anesthesia or local anesthesia on Patients with ischemic cerebrovascular disease undergoing interventional surgery(a cohort study).We prospectively screened consecutive patients with ischemic cerebrovascular disease who were consecutively enrolled with onset time greater than 48 h,intracranial artery stenosis confirmed by digital subtraction angiography(DSA),and responsible artery stenosis degree of 70%-99%.They were divided into general anesthesia group and local anesthesia group according to the different anesthesia methods.The choice of anaesthetic method in this study was decided in an interdisciplinary manner by a neurologist and an anaesthetist.General anesthesia was preferred for patients with surgical site in the middle cerebral artery,basilar artery,severely tortuous path,Mori type B or C lesion,stenosis ≥ 90%,and poor patient cooperation.The surgical site is in the internal carotid artery ophthalmic artery segment,vertebral artery,good vascular path,Mori type a lesion,the degree of stenosis 70%-90%,and better cooperation are the factors that tend to local anesthesia.Local anesthesia was per-formed by the operating surgeon by subcutaneous injection of lidocaine at the puncture site.General anesthesia was administered with propofol,fentanyl,remifentanil,and cisatracurium.The anesthesia depth target was bis 40 to 60,and the intraoperative blood pressure target was within ± 20% of the basal value.Patients’ baseline characteristics,location and extent of stenosis,type of endovascular treatment,operative time,anesthesia modality,intraoperative blood pressure drop,postoperative follow-up and the incidence of perioperative neurocognitive complications,perioperative stroke,30 day postoperative mortality,and 3-month postoperative neurological outcome were recorded.The primary outcome measure was neurologic independence at 3 months postoperatively,and the primary safety measures were the incidence of intraoperative hypotension and perioperative stroke.Neurologic independence was assessed with the modified Rankin Scale(m RS),with Mrs scores > 2 defined as poor functional outcome.Part 2: Effect of remimazolam plus propofol in patients undergoing interventional procedures for ischemic cerebrovascular disease(Prospective,double-blind,randomized controlled study).105 patients undergoing elective endovascular intervention for intracranial arterial stenosis randomly divided into three groups by simple randomization method: group P(propofol group),R1 group(0.1mg/kg?h remimazolam plus propofol group)and R2 group(0.2 mg/kg?h remimazolam plus propofol group),35 cases in each group.Induction of anesthesia: both R1 and R2 groups were intravenously injected with remimazolam(0.06 mg/kg)plus propofol,and P group received propofol alone(TCI 0.6～4.0μg/ml)by infusion to achieve a MOAA/s score of 0 and BIS of 40-60 after completion of tracheal intubation.Maintenance of anesthesia: R1(0.1 mg/kg/h)and R2(0.2 mg/kg/h)groups were treated with continuous intravenous pump infusion of remimazolam plus propofol(TCI 0.6～3.0 μg/ml);In P group,propofol(TCI 0.6～3.0 μg/ml)was continuously infused,and BIS was maintained from 40 to 60 intraoperatively until it was discontinued.Intraoperative hemodynamic fluctuation,perioperative neurocognitive function and prognosis.The general conditions,surgery and anesthesia-related information of the three groups of patients were recorded,and the three groups of patients were observed and recorded before surgery(T0),before induction(T1),before tracheal intubation(T2),immediately after tracheal intubation(T3),and the start of surgery.(T4),balloon dilation or stent placement(T5),immediately after surgery(T6),immediately after tracheal extubation(T7),when leaving the recovery room(T8),the morning of the first postoperative day(T9),and after surgery Afternoon on day 1(T10),morning on day 2 after operation(T11),afternoon on day 2 after operation(T12),morning on day 3 after operation(T13),and afternoon on day 3after operation(T14)Changes in MAP and HR were recorded,and perioperative adverse reactions and serious complications were recorded.The amount of 3-Minute Diagnostic Interview for the Confusion Assessment Method(3D-CAM)and CAM-Chinese Reversion(CAM-CR)used at time points such as 1 day before surgery,1 day after surgery,3 days after surgery,7 days after surgery,1 month after surgery,3 months after surgery,and 6 months after surgery The incidence of delirium was assessed with the MMSE scale,the cognitive function was assessed with the MMSE scale,the neurological recovery was assessed with the m RS scale,and the postoperative quality of life was assessed with the BI scale.Results Part 1: 1.A total of 124 patients were included in this study.There were 7 patients(5.6%)who developed perioperative stroke,including 6 patients(4.8%)with ischemic stroke and 1 patient(0.8%)with hemorrhagic stroke.0patients(0%)died 30 days after surgery.Of the 124 patients who completed the3-month postoperative follow-up,108 patients were lost to follow-up(12.9%).13patients(12%)had a poor postoperative neurological outcome.2.Of the 124 patients,95 patients received general anesthesia and 29 patients received local anesthesia.ASA grade and comorbidities(diabetes mellitus,coronary heart disease,Charlson comorbidity index),the local anesthesia group showed greater severity than the general anesthesia group(P<0.05),Other baseline data,comorbidities,etc.were not comparable.Compared with the local anesthesia group,the general anesthesia group had a higher incidence of intraoperative hypotension [MAP decrease ≥ 20% incidence(71.6% vs 20.7%,P < 0.001)and MAP decrease ≥ 30% incidence(36.8% vs 6.9%,P = 0.002)] and a greater degree of intraoperative hypotension(ΔMAP)was greater [25.00(25.00-35.33)mm Hg vs 8.5(13.00-21.50)mm Hg,P = 0.041].The incidence of postoperative hypotension was lower in the general anesthesia group compared with the local anesthesia group [MAP decrease ≥ 20%(36.8% vs 69.0%,P = 0.003)].Periprocedural stroke occurred in 7 patients(7.4%)in the general anesthesia group and 0 patients(0%)in the local anesthesia group(P = 0.05);There was no significant difference in the incidence of delirium on postoperative day 1 between the general anesthesia group(13.7%)and the local anesthesia group(6.9%)(P >0.05);On the first day after operation,cognitive impairment occurred in 8 cases(8.6%)of the general anesthesia group and 1 case(3.4%)of the local anesthesia group,and there was no significant difference(P > 0.05).No patients died in both the general and local anesthesia groups.108 of 124 patients completed the 3-month postoperative follow-up,including 79 in the general anesthesia group and29 in the local anesthesia group.11 patients(13.9%)in the general anesthesia group had a poor functional outcome(m RS score > 2)at 3 months after surgery compared with 2 patients(6.9%)in the local anesthesia group,with no significant difference between the 2 groups(P > 0.05).3.Logistic regression analysis results:general anesthesia was a risk factor for intraoperative hypotension(P < 0.001).Delirium on postoperative day 1(OR = 17.809,95%CI: 1.528-207.538,P = 0.022)and surgical site located in basilar artery(OR = 48.138,95%CI: 2.533-914.958,P = 0.010)were independent risk factors for the occurrence of perioperative stroke in patients undergoing interventional procedures for ischemic cerebrovascular disease.Poorer preoperative BI(OR = 0.917,95%CI: 0.877-0.960,P < 0.01)and poorer preoperative MMSE(OR = 0.750,95%CI: 0.603-0.932,P = 0.01)were independent risk factors for poor 3-month postoperative functional outcome in patients undergoing interventional procedures for ischemic cerebrovascular disease,but anesthesia method was not found to be associated with perioperative stroke(P = 0.198)or poor functional outcome(P = 0.509).Part 2: A total of 95 patients were finally included in the statistical analysis.There was no significant difference in the general data before and during operation among the three groups(P>0.05).Comparing the recovery time and extubation time of the three groups,the R2 group was significantly shorter than the R1 group and the P group(P<0.05).Hemodynamic: Intraoperative ΔMAP in R1 group was significantly lower in P and R2 group(P<0.05).ΔMAP after operation in R2 group Compared with R1 group and P group,it was significantly higher(P<0.05).The intraoperative HR in the R2 group was significantly higher than that in the P group at T2 and T3(P<0.05),and the postoperative ΔHR in the R2 group was significantly lower than that in the R1 group(P<0.05).Comparison of intraoperative use of anesthetics and vasoactive drugs: The intraoperative dosage of propofol in the R1 and the R2 group was significantly lower than that in the P group(P<0.0001),and the intraoperative ephedrine dosage in the R1 group was significantly lower than that in the P group(P<0.05).Comparison of perioperative adverse reactions: the incidence of recovery ventricular tachycardia in R1 group was significantly higher than that in R2 and P group(P<0.05),and the incidence of intraoperative hypotension(MAP decrease ≥20%)in R1 group was significantly lower than that in P group(P<0.05),the incidence of intraoperative hypotension in R2 group was significantly higher than that in R1 group(P<0.05).Perioperative neurocognitive function comparison: there was no significant difference in the incidence of postoperative delirium among the three groups(P>0.05);the CAMCR score on the first day after the operation in the R1 group was significantly lower than that in the P and R2 groups(P<0.05),the CAM-CR score of the R1 group on the 7th day after operation was significantly lower than the P group(P<0.05).There was no significant difference in the MMSE score and the incidence of PND among the three groups at various time points after operation(P>0.05).There was no significant difference in the neurological outcome and BI index at 30 day postoperative mortality,3 days,30 days,90 days and 180 days after operation(P>0.05);The m RS scores of the three groups at 30,90,and 180 days after surgery were decreased compared with those before surgery,and the BI index was increased compared with those before surgery(P<0.05).Conclusions 1.Ischemic cerebrovascular interventional procedures may be performed under the selection of general or regional anesthesia based on individualized principles;2.Surgical site located in the basilar artery and postoperative delirium are independent risk factors for patients’ perioperative stroke;Poor preoperative BI and MMSE score were independent risk factors for poor outcomes at 3 months after surgery;3.The use of remimazolam for general anesthesia in patients with ischemic cerebrovascular disease is safe and effective,but dose-dependent hypotension may occur;When combined with propofol,remimazolam(0.1 mg/kg·h)can provide more stable hemodynamics and remimazolam(0.2 mg/kg·h)can significantly shorten the recovery time of patients;Remimazolam may accelerate the early recovery of neurocognitive function in patients with ischemic cerebrovascular disease.Part Ⅰ.Effects of General Anesthesia or Local Anesthesia on Patients with Ischemic Cerebrovascular Disease undergoing Interventional SurgeryObjective and significance Stroke is the leading cause of death and disability in adults in China.Ischemic stroke is the most common type of stroke,and the incidence of ischemic stroke is increasing worldwide in the recent decade.Intracranial artery stenosis is the most common cause of ischemic stroke,but the optimal anesthetic strategy for such patients is less frequently reported.Whether anaesthetic decision-making(general or regional anaesthesia)affects perioperative safety and outcomes in patients undergoing interventional surgery for ischaemic cerebrovascular disease is still missing clinical evidence.In this study,a prospective cohort study of patients undergoing elective interventional surgery for ischemic cerebrovascular disease was performed to compare the differences in perioperative safety and outcomes between general anesthesia and regional anesthesia in patients undergoing interventional surgery for ischemic cerebrovascular disease;We also analyzed the factors associated with intraoperative hypotension,perioperative stroke and outcome.Methods This study was a cohort study.We prospectively screened consecutive patients with ischemic cerebrovascular disease who underwent endovascular treatment between August 2020 and December 2021 in the Department of Neurology,the First Affiliated Hospital of Guangxi Medical University,and who were consecutively enrolled with onset time greater than 48 h,intracranial artery stenosis confirmed by digital subtraction angiography(DSA),and responsible artery stenosis degree of 70%-99%.They were divided into general anesthesia group and local anesthesia group according to the different anesthesia methods.The choice of anaesthetic method(general or regional anaesthesia)in this study was decided in an interdisciplinary manner by a surgically qualified neurologist and an anaesthetist above the attending level.The anesthesia method was chosen based on a comprehensive judgment of lesion location,morphology,degree of stenosis,proximal vessel route,type of stent,patient’s conscious state and cooperation,and operation time.General anesthesia was preferred for patients with surgical site in the middle cerebral artery,basilar artery,severely tortuous path,Mori type B or C lesion,stenosis ≥ 90%,and poor patient cooperation.The surgical site is in the internal carotid artery ophthalmic artery segment,vertebral artery,good vascular path,Mori type a lesion,the degree of stenosis 70%-90%,and better cooperation are the factors that tend to local anesthesia.Local anesthesia was per-formed by the operating surgeon by subcutaneous injection of lidocaine at the puncture site.General anesthesia was induced with propofol,fentanyl,remifentanil,and cisatracurium,maintained with propofol,remifentanil,and cisatracurium,and the patient was intubated and mechanically ventilated,extubated as early as possible in the recovery room from intraoperative Pico transfer,and then transferred back to the ward.The anesthesia depth target was bis 40 to 60,and the intraoperative blood pressure target was within ± 20% of the basal value.Patients’ baseline characteristics,location and extent of stenosis,type of endovascular treatment,operative time,anesthesia modality,intraoperative blood pressure drop,postoperative follow-up and the incidence of perioperative neurocognitive complications,perioperative stroke,30 day postoperative mortality,and 3-month postoperative neurological outcome were recorded.The primary outcome measure was neurologic independence at 3 months postoperatively,and the primary safety measures were the incidence of intraoperative hypotension and perioperative stroke.Neurologic independence was assessed with the modified Rankin Scale(m RS),with m RS scores > 2 defined as poor functional outcome.The analysis compared the data of the general anesthesia group and the local anesthesia group;To explore factors influencing intraoperative hypotension,perioperative stroke,and outcome after endovascular treatment in patients with ischemic cerebrovascular disease.Results 1.A total of 124 patients were included in this study,with a mean age of 62.9 ± 8.4 years and 94 males(75.8%).There were 7 patients(5.6%)who developed perioperative stroke,including 6 patients(4.8%)with ischemic stroke and 1 patient(0.8%)with hemorrhagic stroke.0 patients(0%)died 30 days after surgery.Of the 124 patients who completed the 3-month postoperative follow-up,108 patients were lost to follow-up(12.9%).13 patients(12%)had a poor postoperative neurological outcome.2.Of the 124 patients,95 patients received general anesthesia and 29 patients received local anesthesia.There was no significant difference between the groups at baseline,such as sex,age,BMI,comorbidities(hypertension,AF,atherosclerosis,and dyslipidemia),history of previous stroke,admission MAP,Admission National Institutes of Health Stroke Scale(NIHSS)score,preoperative m RS score,Barthel Index(BI),index mini mental state examination(MMSE)scores(P > 0.05),However,in terms of ASA grade and comorbidities(diabetes mellitus,coronary heart disease,Charlson comorbidity index),the local anesthesia group showed greater severity than the general anesthesia group(P < 0.05).Compared with the local anesthesia group,the general anesthesia group had a higher incidence of intraoperative hypotension [MAP decrease ≥ 20% incidence(71.6% vs 20.7%,P < 0.001)and MAP decrease ≥ 30% incidence(36.8% vs 6.9%,P = 0.002)] and a greater degree of intraoperative hypotension(ΔMAP)was greater [25.00(25.00-35.33)mm Hg vs 8.5(13.00-21.50)mm Hg,P = 0.041].The incidence of postoperative hypotension was lower in the general anesthesia group compared with the local anesthesia group [MAP decrease ≥ 20%(36.8% vs 69.0%,P = 0.003)].Periprocedural stroke occurred in 7 patients(7.4%)in the general anesthesia group and 0 patients(0%)in the local anesthesia group(P = 0.05);The incidence of delirium on the first postoperative day was higher in the general anesthesia group(13.7%)compared with the local anesthesia group(6.9%),but the difference was not statistically significant(P > 0.05);8 patients(8.6%)in the general anesthesia group developed cognitive dysfunction on the first postoperative day compared with 1 patient(3.4%)in the local anesthesia group,although the difference did not reach statistical significance(P > 0.05).No patients died in both the general and local anesthesia groups.108 of 124 patients completed the 3-month postoperative follow-up,including 79 in the general anesthesia group and 29 in the local anesthesia group.11 patients(13.9%)in the general anesthesia group had a poor functional outcome(m RS score > 2)at 3 months after surgery compared with 2 patients(6.9%)in the local anesthesia group,with no significant difference between the 2 groups(P > 0.05).3.Logistic regression analysis results: general anesthesia was a risk factor for intraoperative hypotension(P < 0.001).Delirium on postoperative day 1(OR = 17.809,95%CI: 1.528-207.538,P = 0.022)and surgical site located in basilar artery(OR = 48.138,95%CI: 2.533-914.958,P = 0.010)were independent risk factors for the occurrence of perioperative stroke in patients undergoing interventional procedures for ischemic cerebrovascular disease.Poorer preoperative BI(OR = 0.917,95%CI: 0.877-0.960,P < 0.01)and poorer preoperative MMSE(OR = 0.750,95%CI: 0.603-0.932,P = 0.01)were independent risk factors for poor 3-month postoperative functional outcome in patients undergoing interventional procedures for ischemic cerebrovascular disease,but anesthesia method was not found to be associated with perioperative stroke(P = 0.198)or poor functional outcome(P = 0.509).Conclusions 1.1.General anesthesia or local anesthesia,both of which can be used for interventional procedures of ischemic cerebrovascular disease,has similar perioperative safety and prognosis,but pay attention to the prevention and treatment of hypotension during general anesthesia.2.Endovascular treatment of the basilar artery at the site of stenosis patients are at high risk of perioperative stroke,and the assessment of postoperative delirium may be clinically valuable in the prediction of perioperative stroke in patients with ischemic cerebrovascular disease;3.The worse the preoperative daily living ability and cognitive level ischemic cerebrovascular disease patients treated with endovascular therapy,the worse the preoperative can identify high-risk patients by BI index and MMSE scale.Part Ⅱ.Effect of Remimazolam plus Propofol in Patients undergoing Interventional Procedures for Ischemic Cerebrovascular DiseaseObjective and significance Hypotension,as a potential cause of injury in patients with ischemic cerebrovascular disease,deserves higher attention in the clinic.Sedation with high-dose propofol is associated with hypotension and may be harmful in patients with ischemic cerebrovascular disease,therefore,drug selection and dosage need to be re-evaluated and scrutinized.Early studies have shown that remimazolam can be used for the induction and maintenance of general anesthesia and that hypotension occurs less frequently than propofol.Therefore,further evaluation of the use of remimazolam in general anesthesia of patients with ischemic cerebrovascular disease is needed.Methods This study is a prospective,double-blind,randomized controlled trial.From August 2020 to October 2021,105 patients in the First Affiliated Hospital of Guangxi Medical University who underwent elective endovascular interventional therapy for intracranial artery stenosis were enrolled and randomly divided into three groups by simple randomization method: group P(propofol group),R1 group(0.1 mg/kg?h remimazolam plus propofol group)and R2 group(0.2 mg/kg?h remimazolam plus propofol group),35 cases in each group.Intraoperative hemodynamic fluctuation,perioperative neurocognitive function and prognosis.The general conditions,surgery and anesthesia-related information of the three groups of patients were recorded,and the three groups of patients were observed and recorded before surgery(T0),before induction(T1),before tracheal intubation(T2),immediately after tracheal intubation(T3),and the start of surgery.(T4),balloon dilation or stent placement(T5),immediately after surgery(T6),immediately after tracheal extubation(T7),when leaving the recovery room(T8),the morning of the first postoperative day(T9),and after surgery Afternoon on day 1(T10),morning on day 2 after operation(T11),afternoon on day 2 after operation(T12),morning on day 3 after operation(T13),and afternoon on day 3 after operation(T14)Changes in MAP and HR were recorded,and perioperative adverse reactions and serious complications were recorded.The amount of 3-Minute Diagnostic Interview for the Confusion Assessment Method(3D-CAM)and CAM-Chinese Reversion(CAM-CR)used at time points such as 1 day before surgery,1 day after surgery,3 days after surgery,7 days after surgery,1 month after surgery,3 months after surgery,and 6 months after surgery The incidence of delirium was assessed with the MMSE scale,the cognitive function was assessed with the MMSE scale,the neurological recovery was assessed with the m RS scale,and the postoperative quality of life was assessed with the BI scale.Main outcome measures were intraoperative blood pressure change indicators – ΔMAP(ΔMAP is the absolute value of the difference between MAP and the basal value of MAP at each time point)and the incidence of hypotension(≥ 20% decrease in blood pressure compared with the basal value).Secondary outcomes including perioperative hemodynamic measures,vasoactive drug use,surgical anesthesia related adverse effects and complications,recovery from anesthesia,perioperative neurocognitive function and complications,and 3-month postoperative neurological outcome.Results A total of 95 patients were finally included in the statistical analysis.There was no significant difference in the general data before and during operation among the three groups(P>0.05).There was no difference in the mean intraoperative BIS among the three groups(P>0.05).Comparing the recovery time and extubation time of the three groups,the R2 group was significantly shorter than the R1 group and the P group(P<0.05).There was no significant difference in map at all time points during the perioperative period among the three groups(P>0.05).Intraoperative ΔMAP in R1 group was significantly lower in P and R2 group(P<0.05).ΔMAP after operation in R2 group Compared with R1 group and P group,it was significantly higher(P<0.05).Comparison of HR at each time point among the three groups: the intraoperative HR in the R2 group was significantly higher than that in the P group at T2 and T3(P<0.05),and the postoperative ΔHR in the R2 group was significantly lower than that in the R1 group(P<0.05)),and there was no significant difference in HR and ΔHR at other time points among the three groups(P>0.05).Comparison of intraoperative use of anesthetics and vasoactive drugs: The intraoperative dosage of propofol in the R1 and the R2 group was significantly lower than that in the P group(P<0.0001),and the intraoperative ephedrine dosage in the R1 group was significantly lower than that in the P group(P<0.05).Comparison of perioperative adverse reactions: the incidence of recovery ventricular tachycardia in R1 group was significantly higher than that in R2 and P group(P<0.05),and the incidence of intraoperative hypotension(MAP decrease ≥20%)in R1 group was significantly lower than that in P group(P<0.05),the incidence of intraoperative hypotension in R2 group was significantly higher than that in R1 group(P<0.05).Perioperative neurocognitive function comparison: there was no significant difference in the incidence of postoperative delirium among the three groups(P>0.05);the CAMCR score on the first day after the operation in the R1 group was significantly lower than that in the P and R2 groups(P<0.05),the CAM-CR score of the R1 group on the 7th day after operation was significantly lower than the P group(P<0.05).There was no significant difference in the MMSE score and the incidence of PND among the three groups at various time points after operation(P>0.05).Comparison of postoperative 30-day mortality and postoperative neurological outcome: There were no deaths in the three groups 30 days after surgery.There was no significant difference in m RS score and functional improvement before operation,on the 3-,30-,90-and 180 days after operation between the three groups(P>0.05).There was no significant difference in the BI index between the three groups before surgery,on the 3-,30-,90-,and on the 180 day after surgery(P>0.05).In the three groups,the m RS scores at 30-,90-and 180 days after surgery were lower than those before surgery,and the BI index was higher than those before surgery(P<0.05).Conclusions 1.Remimazolam is safe and effective for general anesthesia in patients with ischemic cerebrovascular disease,but dose-dependent hypotension may occur;2.Combined with propofol,0.1 mg/kg?h remimazolam can provide more stable hemodynamics;0.2 mg/kg?h remazolam can significantly shorten the recovery time of patients,the optimal dose still needs to be further explored;3.Remimazolam may accelerate the recovery of early postoperative neurocognitive function in patients with ischemic cerebrovascular intervention. |
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