Carotid Artery Stenosis Is Associated with Better Intracranial Collateral Circulation in Stroke Patients

Pienimäki, Juha-Pekka; Sillanpää, Niko; Jolma, Pasi; Protto, Sara

doi:10.1159/000506826

Cited by 12 publications

(11 citation statements)

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“…In the latter study, only a small number of patients with LVO were included and only those with an M1 occlusion were selected for the analysis. Nevertheless, considering recent findings in other studies [7][8][9][10], the association we describe here seems more plausible. Furthermore, intimal ICAC is related to atherosclerotic changes with the presence of plaques and arterial stenosis whereas medial ICAC is considered non-atherosclerotic without compromising the vessel lumen [1,2].…”

Section: Discussionsupporting

confidence: 70%

“…Formation and development of collaterals is generally thought to be stimulated by chronic cerebral hypoperfusion due to obstruction of antegrade blood flow [6]. Accordingly, previous studies found that patients with stenotic cervical [7][8][9] or intracranial [10] atherosclerosis have more extensive collaterals. Histopathological analyses of ICAC specimens revealed that the intimal calcification subtype is reflective of atherosclerotic disease, which is characterized by formation of plaques and narrowing of the vessel lumen.…”

Section: Introductionmentioning

confidence: 99%

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Intracranial carotid artery calcification subtype and collaterals in patients undergoing endovascular thrombectomy

et al. 2021

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Background and aims: Distinct subtypes of intracranial carotid artery calcification (ICAC) have been found (i.e., medial and intimal), which may differentially be associated with the formation of collaterals. We investigated the association of ICAC subtype with collateral status in patients undergoing endovascular thrombectomy (EVT) for ischemic stroke. We further investigated whether ICAC subtype modified the association between collateral status and functional outcome. Methods: We used data from 2701 patients with ischemic stroke undergoing EVT. Presence and subtype of ICAC were assessed on baseline non-contrast CT. Collateral status was assessed on baseline CT angiography using a visual scale from 0 (absent) to 3 (good). We investigated the association of ICAC subtype with collateral status using ordinal and binary logistic regression. Next, we assessed whether ICAC subtype modified the association between collateral status and functional outcome (modified Rankin Scale, 0-6). Results: Compared to patients without ICAC, we found no association of intimal or medial ICAC with collateral status (ordinal variable). When collateral grades were dichotomized (3 versus 0-2), we found that intimal ICAC was significantly associated with good collaterals in comparison to patients without ICAC (aOR, 1.41 [95% CI:1.06-1.89]) or with medial ICAC (aOR,). The association between higher collateral grade and better functional outcome was significantly modified by ICAC subtype (p for interaction = 0.01). Conclusions: Patients with intimal ICAC are more likely to have good collaterals and benefit more from an extensive collateral circulation in terms of functional outcome after EVT.

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Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Intracranial carotid artery calcification subtype and collaterals in patients undergoing endovascular thrombectomy

et al. 2021

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“…Liu et al measured the direction of the ophthalmic artery flow and bilaterally in the internal carotid arteries in a group of 116 patients with unilateral carotid artery stenosis and found that the direction was reversed in 36% of the patients [33]. In another study, Pienimaki et al observed that patients with severe carotid stenosis were four times more likely to develop collateral circulation than patients with nonstenosis and moderate stenosis [34]. In our study, we established the presence of collateral circulation in 44% of patients with unilateral severe carotid artery stenosis or occlusion by DSA (Supplementary Figure 2).…”

Section: Discussionmentioning

confidence: 99%

Optical Coherence Tomography Angiography as a Noninvasive Assessment of Cerebral Microcirculatory Disorders Caused by Carotid Artery Stenosis

Zhu

Zhou

et al. 2021

Disease Markers

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Purpose. Using retinal optical coherence tomography angiography (OCTA), we aimed to investigate the changes in important indicators of cerebral microcirculatory disorders, such as the properties of the radial peripapillary capillaries, vascular complexes, and the retinal nerve fiber layer, caused by carotid stenosis and postoperative reperfusion. Methods. In this prospective longitudinal cohort study, we recruited 40 carotid stenosis patients and 89 healthy volunteers in the First Affiliated Hospital of Harbin Medical University (Harbin, China). Eyes with ipsilateral carotid stenosis constituted the experimental group, while the fellow eyes constituted the contralateral eye group. Digital subtraction angiography, CT perfusion imaging (CTP), and OCTA examinations were performed in all subjects. The vessel density of the radial peripapillary capillaries (RPC), superficial retinal vascular complexes (SVC), deep vascular complexes (DVC), choriocapillaris (CC), and the thickness of the retinal nerve fiber layer (RNFL) were assessed. Propensity-matched analysis was undertaken to adjust for covariate imbalances. Intergroup comparative analysis was conducted, and the paired sample t -test was used to evaluate the preoperative and postoperative changes in OCTA variables. Results. The ocular vessel density in the experimental group was significantly lower than that in the control group (RPC: 55.95 vs. 57.24, P = 0.0161 ; SVC: 48.65 vs. 52.22, P = 0.0006 ; DVC: 49.65 vs. 57.50, P < 0.0001 ). Participants with severe carotid stenosis have reduced contralateral ocular vessel density (RPC 54.30; SVC 48.50; DVC 50.80). Unilateral stenosis removal resulted in an increase in vessel density on both sides, which was detected by OCTA on the 4th day (RPC, P < 0.0001 ; SVC, P = 0.0104 ; DVC, P = 0.0104 ). Moreover, the ocular perfusion was consistent with that established by CTP. Conclusion. OCTA can be used for sensitive detection and accurate evaluation of decreased ocular perfusion caused by carotid stenosis and may thus have the potential for application in noninvasive detection of cerebral microcirculation disorders. This trial is registered with NCT04326842.

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“…Collateral circulation could protect the brain parenchyma from ischemic damage when the normal antegrade ow is obstructed. These patients with ICAS had better collaterals than those with other stroke subtypes like embolism, presumably due to that the ICAS required a longer time for the complete occlusion of arteries, which allowed the development of adequate collaterals before the acute stroke 16 . Secondly, patients underlying ICASS had relatively lower clot burden compared with the embolism-related occlusion.…”

Section: Discussionmentioning

confidence: 96%

Endovascular Treatment of Acute MI Occlusions Due To Underlying Intracranial Atherosclerotic Severe Stenosis

Yan

et al. 2021

Preprint

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Objective: Endovascular treatment (EVT) for acute ischemic stroke with an occlusion of the M1 segment due to intracranial atherosclerotic severe stenosis (ICASS) remains challenging. This study aimed to evaluate the safety and efficacy of EVT for ICASS-related M1 acute occlusion.Methods: We retrospectively reviewed all patients with an ICASS-related M1 acute occlusion underwent EVT at our institution between January 2015 and December 2020. Clinical presentation, baseline characteristics, angiographic and clinical results, technical feasibility, perioperative complications, and follow-up results were evaluated.Results: Twenty-two patients with ICASS-related M1 acute occlusion were included. Eight patients (36.4%) received bridging therapy and the other 14 patients (63.6%) directly underwent EVT. Fifteen patients (68.2%) treated with balloon dilations and stenting as rescue treatment. Six patients (27.3%) received single balloon angioplasty and 5 of these patients treated with staged stenting. One case (4.5%) failed recanalization at the first EVT and successful revascularization was achieved a month later. The mean procedure time was 67.2±20.8 min. Successful revascularization (mTICI≥2b) was achieved in 95.5% (21/22) of patients. Perioperative complications developed in two patients (9.1%) including one hemorrhagic event and one thromboembolic event. Anangiographic follow-up was available in 20 patients (90.9%) at an average of 8.6±3.0 months. The degree of stenosis was worse (10%-30%) in 6 cases (30%) compared with the initial outcomes. The favorable outcomes (mRS≤2) at 3 months follow-up was achieved in 19 patients (86.4%).Conclusions: ICASS-related occlusion in the M1 segment often required a rescue therapy including balloon angioplasty with/without stenting, and this treatment strategy was safe and effective. But single balloon angioplasty at the first EVT generally cannot achieve satisfactory results and often needed staged stenting treatment.

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Carotid Artery Stenosis Is Associated with Better Intracranial Collateral Circulation in Stroke Patients

Cited by 12 publications

References 13 publications

Intracranial carotid artery calcification subtype and collaterals in patients undergoing endovascular thrombectomy

Intracranial carotid artery calcification subtype and collaterals in patients undergoing endovascular thrombectomy

Optical Coherence Tomography Angiography as a Noninvasive Assessment of Cerebral Microcirculatory Disorders Caused by Carotid Artery Stenosis

Endovascular Treatment of Acute MI Occlusions Due To Underlying Intracranial Atherosclerotic Severe Stenosis

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