CHINA-INI is a world-famous organization committed to clinical practice, education, and research, and provides first-class medical experts and innovative care. The Cerebral Revascularization Center (CRC) of CHINA-INI is the forerunner of China in surgical and interventional therapy for treating ischemic cerebrovascular disease. It is the cradle of neuro-intervention in China.
1. A Brief History
More than 20 years ago, Professor Feng Ling (Figure 1) founded a comprehensive center of cerebral revascularization in China after receiving standardized training in France. Professor Feng together with Shenmao Li, Meng Li, Zhongrong Miao, Fengshui Zhu, Xunming Ji, Liqun Jiao) (Figure 2), made up the core workforce at that time.
Fig 1, Prof. Feng Ling, the founder of the CHINA-INI
Fig 2, members of the ischemic group (2001)
More than 500 trainees/fellows from CHINA-INI have become academic leaders and senior experts in neuro-intervention therapy after ten years of development. A comprehensive treatment system involving radio-diagnosis, interventional treatment, and surgical treatment has been successfully established and promoted in most provincial and municipal hospitals in China through the team's effort.
2. Clinical Work
Today, the Cerebral Revascularization Center (CRC) of CHINA-INI is one of the largest stroke centers in China. It has 41 beds, 10 professional doctors, and 2 residents (Figure 3). The Cerebral Revascularization Center (CRC) 's mission is to improve patients' health by setting the standard of excellence in medical education, research, and clinical care.
Figure 3, members of the ischemic group (2020)
The quantity and quality of the major procedures are as follows (Figure 4-6):
Fig 4, the numbers of major procedures from 2001-2019
Fig 5, the numbers and incidence of MAE of CEA and CAS from 2001-2019
Fig 6, the numbers and incidence of MAE of ICAS and Bypass from 2001-2019
3. Innovative Work
To improve the interventional treatment selection, we have started a study with the support of the Chinese government. More than 30 patients with intracranial stenosis had the lesions crossed with a pressure guidewire, and Pd/Pa measured, with no additional complications.
Meanwhile, a good correlation between anatomic and functional indices was found in a particular group by composite analysis of FFR and ASL-CBF pre- and post-stenting. A preliminary cut-off value was found and would be further verified through randomized controlled trials. Based on computational fluid dynamics and machine learning, non-invasive modalities such as FFR-DSA and FFR-4D PCMRA are during development.
OCT enables a much more accurate assessment of intracranial artery wall pathology, including plaque composition, interaction with stents, balloons, and thrombosis formation. In our prospective study, OCT has been applied in more than 140 cases. Virtual reality and 3D reconstruction of the microstructure detected by OCT provides more information for guiding and improving our management. Besides, based on patient-specific data and 3D printing, an in-vitro model could be easily reconstructed to facilitate learning and the testing of new devices.
4. Major Research Programs
◆China Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis (CASSISS) Study NCT01763320
◆ The Carotid and Middle Cerebral Artery Occlusion Surgery Study (CMOSS) NCT01758614
◆ Revascularization of Extracranial Carotid Artery Stenosis (RECAS) NCT01994187
◆Clinical Registration Trial of Intracranial Stenting for Patients with Symptomatic Intracranial Artery Stenosis (CRITICAS) NCT01994161
Total funds: ＞2,000,000 $.
5. Education
Education is an essential part of our work, which appeals to doctors who specialized in neurosurgery and neurology worldwide to learn interventional and surgical techniques. Using the latest tools and teachings available to scientists and doctors, we become caregivers, discoverers, and inventors. We have a diversified learning activity and a regular schedule for education (Figure 7). We have recruited 39 sessions of students up to now and the total number exceeds 500. Therefore, achieving a high educational goal has become an essential part of the Cerebral Revascularization Center (CRC) 's mission.
Fig 7, life as a fellow in the ischemic group of CHINA-INI
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