颈动脉狭窄是脑梗死的重要危险因素，近年来血管内治疗的发展为颈动脉狭窄提供了有效的治疗手段。但是，既往依靠CTA、MRA或DSA估算颈动脉的狭窄程度，无法精确衡量脑血管的结构及血流动力学变化，制约了血运重建的临床疗效。为此，我们率先将光学相干断层成像（OCT）技术用于评估颈动脉狭窄的管腔形态和斑块性质，并初步建立了以OCT结果推测狭窄远端血流储备的预测模型。我们还发现OCT可用于精确评估血运重建后支架-血管关系。基于此，我们拟通过OCT精确测量管腔狭窄程度和斑块类型，进一步验证OCT结果预测血流动力学变化，进而评估血管结构和功能对颈动脉狭窄自然病程及血运重建后临床转归的的影响。最后，通过一项干预性试验，头对头比较OCT指导下的血管内治疗与传统DSA指导下的介入治疗的临床疗效。这一课题，旨在为脑梗死的血运重建治疗提供新的术前治疗指征和术后评价方法，为优化脑梗死的防治策略提供循证医学依据。

Carotid stenosis is an important risk factor of ischemic stroke. Recent advances in the endovascular technique provided effective strategies for the treatment of carotid stenosis. However, previous CTA, MRA, and DSA methods can not reveal the plaque composition and the hemodynamic features of the carotid artery, thereby limiting the clinical efficacy of endovascular strategy of carotid stenosis. To this end, we utilized optical coherence tomography (OCT) to evaluate the blood vessel morphology and plaque characteristics. We also established a prediction model of distal hemodynamic changes based on OCT findings. After the endovascular treatment, OCT can be used to assess the stent-vessel relationship, including dissections, prolapse, thrombus, or malposition, guiding extra remedial actions. Based on these findings, we aim to further measure the artery lumen structure and plaque composition and confirm the OCT-derived fractional flow reserve model. These outcomes were then examined for their potential influence of natural outcome or the endovascular prognosis of carotid stenosis cohort patients. We then compared the clinical efficacy of OCT-guided endovascular treatment and traditional DSA-guided endovascular treatment. This study is to provide novel vascular assessment before and after the intraarterial manipulation, thus providing clinical evidence for the prevention of ischemic stroke.