Facing Time in Ischemic Stroke: An Alternative Hypothesis for Collateral Failure

Pham, Mirko; Bendszus, Martin

doi:10.1007/s00062-016-0507-2

Cited by 36 publications

(22 citation statements)

References 60 publications

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“…The clinical relevance of collaterals including those between the cerebral arteries was originally described by Charcot in the 19 th century and was confirmed by more recent research with endovascular clot retrieval procedures. [ 47 ] Such collaterals may not be present in all animal species or in all individuals of a species, and they may open and close under various conditions. [ 48 ] The effect of neural regulation of collateral blood flow has not, to our knowledge, been studied directly.…”

Section: Introductionmentioning

confidence: 99%

Facial nerve stimulation as a future treatment for ischemic stroke

Borsody¹,

Sacristán²

2016

Brain Circ

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Stimulation of the autonomic parasympathetic fibers of the facial nerve system (hereafter simply “facial nerve”) rapidly dilates the cerebral arteries and increases cerebral blood flow whether that stimulation is delivered at the facial nerve trunk or at distal points such as the sphenopalatine ganglion. Facial nerve stimulation thus could be used as an emergency treatment of conditions of brain ischemia such as ischemic stroke. A rich history of scientific research has examined this property of the facial nerve, and various means of activating the facial nerve can be employed including noninvasive means. Herein, we review the anatomical and physiological research behind facial nerve stimulation and the facial nerve stimulation devices that are in development for the treatment of ischemic stroke.

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Section: Introductionmentioning

confidence: 99%

Facial nerve stimulation as a future treatment for ischemic stroke

Borsody¹,

Sacristán²

2016

Brain Circ

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“…This change in the flow seems to be related to as of yet unidentified cellular processes within the ischaemic penumbra as they are oedema-independent 30. Other proposed mechanisms are cerebral venous steal,31 reversed Robin Hood syndrome32 and blood pressure fluctuations secondary to autonomic dysfunction33 as well as others 34. Interestingly, with regard to the latter, a recent study by Xiong et al 35 showed that 76.5% of patients with relatively mild strokes (mean NIHSS score 4.4) had severe autonomic dysfunction and that those with more severe autonomic dysfunction had poorer outcomes at 2 months.…”

Section: Discussionmentioning

confidence: 96%

Mechanical thrombectomy in patients with M1 occlusion and NIHSS score ≤5: a single-centre experience

et al. 2016

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BackgroundThe recent success of several mechanical thrombectomy trials has resulted in a significant change in management for patients presenting with stroke. However, it is still unclear how to manage patients that present with stroke and low National Institutes of Health Stroke Scale (NIHSS) ≤5. We sought to review our experience of mechanical thrombectomy in patients with low NIHSS and confirmed M1 occlusion.MethodsWe retrospectively analysed our prospectively maintained database of all patients undergoing mechanical thrombectomy between January 2008 and August 2016. We identified 41 patients with confirmed M1 occlusion and low NIHSS (≤5) on admission to our hospital. We collected demographic, radiological, procedural and outcome data.ResultsThe mean age of patients was 72±14, with 20 male patients. Associated medical conditions were common with hypertension seen in ∼80%. Just over 50% presented with NIHSS 4 or 5. The average ASPECTS score on admission was 8.8 (range 6–10), and the average clot length 10 mm. Angiographically Thrombolysis in Cerebral Infarction (TICI) ≥2b was obtained in 87.8% of patients. 7 patients had haemorrhage on follow-up, 2 of which were symptomatic. Of 40 patients with 90-day follow-up, 75% had modified Rankin Scale (mRS) score 0–2. There were 3 deaths at 90 days.ConclusionsMechanical thrombectomy in patients with low NIHSS and proximal large vessel occlusion is technically possible and carries a high degree of success with good safety profile. Patients with low NIHSS and confirmed occlusion should be considered for mechanical thrombectomy.

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“…Clinically, blood flow through the pial collaterals defines the degree of ischemia in the penumbra of cortical infarcts, and thus influences infarct growth, prognosis, and response to therapy [7,[10][11][12]. Among recent trials of endovascular thrombectomy [13][14][15][16][17], data from the ESCAPE trial that included multiphase CT angiography demonstrated a strong association between robust pial collateral flow before recanalization and favorable outcome after recanalization [13,18]. The DAWN and DEFUSE3 trials that evaluated patients following late thrombectomy (6 to 24 h after stroke onset) reported significant benefits of delayed endovascular treatment [19,20].…”

Section: Introductionmentioning

confidence: 99%

Impaired Collateral Flow in Pial Arterioles of Aged Rats During Ischemic Stroke

Shuaib

et al. 2019

Transl. Stroke Res.

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Cerebral collateral circulation and age are critical factors in determining outcome from acute ischemic stroke. Aging may lead to rarefaction of cerebral collaterals, and thereby accelerate ischemic injury by reducing penumbral blood flow. Dynamic changes in pial collaterals after onset of cerebral ischemia may vary with age but have not been extensively studied. Here, laser speckle contrast imaging (LSCI) and two-photon laser scanning microscopy (TPLSM) were combined to monitor cerebral pial collaterals between the anterior cerebral artery (ACA) and the middle cerebral artery (MCA) in young adult and aged male Sprague Dawley rats during distal middle cerebral artery occlusion (dMCAo). Histological analysis showed that aged rats had significantly greater volumes of ischemic damage than young rats. LSCI showed that cerebral collateral perfusion declined over time after stroke in aged and young rats, and that this decline was significantly greater in aged rats. TPLSM demonstrated that pial arterioles narrowed faster after dMCAo in aged rats compared to young adult rats. Notably, while arteriole vessel narrowing was comparable 4.5 h after ischemic onset in aged and young adult rats, red blood cell velocity was stable in young adults but declined over time in aged rats. Overall, red blood cell flux through pial arterioles was significantly reduced at all time-points after 90 min post-dMCAo in aged rats relative to young adult rats. Thus, collateral failure is more severe in aged rats with significantly impaired pial collateral dynamics (reduced diameter, red blood cell velocity, and red blood cell flux) relative to young adult rats.

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Facing Time in Ischemic Stroke: An Alternative Hypothesis for Collateral Failure

Cited by 36 publications

References 60 publications

Facial nerve stimulation as a future treatment for ischemic stroke

Facial nerve stimulation as a future treatment for ischemic stroke

Mechanical thrombectomy in patients with M1 occlusion and NIHSS score ≤5: a single-centre experience

Impaired Collateral Flow in Pial Arterioles of Aged Rats During Ischemic Stroke

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