Collateral blood vessels in acute ischemic stroke: a physiological window to predict future outcomes

Abstract

Collateral circulation is a physiologic pathway that protects the brain against ischemic injury and can potentially bypass the effect of a blocked artery, thereby influencing ischemic lesion size and growth. Several recent stroke trials have provided information about the role of collaterals in stroke pathophysiology, and collateral perfusion has been recognized to influence arterial recanalization, reperfusion, hemorrhagic transformation, and neurological outcomes after stroke. Our current aim is to summarize the anatomy and physiology of the collateral circulation and to present and discuss a comprehensible review of the related knowledge, particularly the effects of collateral circulation on the time course of ischemic injury and stroke severity, as well as imaging findings and therapeutic implications.

Clinical outcomes of acute ischemic stroke patients treated by direct catheter-based trombectomy depending on their baseline characteristics

“…Všech pět pacientů (4,5 %) se symptomatickým intrakraniálním krvácením zemřelo. Detailní charakteristika pacientů obou skupin je uvedena v tabulce 2. fi citem a menším objemem infarzované mozkové tkáně [25,26]. Naše výsledky mohou být ovlivněny skutečností, že v naší studijní skupině byli kuřáci mladší než nekuřáci (68,1 vs. 62,4, p = 0,01).…”

The significance of collateral circulation in acute ischemic stroke

“…The last decade was marked by studies employing the endovascular treatment of intrac-ranial and extracranial occlusions, and it was only recently that several studies confirmed that mechanical thrombectomy following the endovascular approach is superior to standard treatment with or without intravenous thrombolysis [7]. However, the outcomes after these treatments are still variable and do not depend only on the method, but also on specific biological characteristics of the patient [8].…”

“…The degree of development of collateral circulation also affects the size of the infarct lesion. All these findings have put the relationship between collaterals and the possibility of predicting the evolution of infarction and clinical outcome after AIS in the focus of scientific interest in recent years [8,13].…”

“…Digital subtraction angiography (DSA) is a gold standard for the anatomic evaluation of collateral circulation [8]. This technique enables spatial and temporal visualization of collateral circulation, providing also feedback about dilatation and phases of filling collaterals.…”

Collateral blood flow in different cerebrovascular hierarchy provides endogenous protection in cerebral ischemia

“…Anastomotic connections of the cortical surface and interconnections of subsurface microvasculature are the two principal connections underlying the collateral vasculature . Previous studies have found that extensive anastomotic connections facilitate partial reperfusion of ischemic territories after focal stroke . However, the potential recruitment of subsurface microvessels and their contribution to focal ischemia are yet to be studied because of the limitation of imaging technique and animal models.…”