Collateral Circulation

Liebeskind, David S

doi:10.1161/01.str.0000086465.41263.06

Cited by 933 publications

(789 citation statements)

References 55 publications

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“…Oligemia can affect protein synthesis required for synaptic plasticity associated with learning and memory 35, 36. In addition, the temporal lobes appear especially vulnerable to CBF reductions possibly due to a less extensive network of collateral blood flow sources 37. Second, as CBF decreases, adherens and tight junctions in the blood–brain barrier are disrupted, resulting in increased diffusion of lipid‐soluble proteins across capillary walls.…”

Section: Discussionmentioning

confidence: 99%

Subclinical Compromise in Cardiac Strain Relates to Lower Cognitive Performances in Older Adults

Kresge

Khan

Wagener

et al. 2018

JAHA

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BackgroundGlobal longitudinal strain (GLS), reflecting total shortening of the myocardium during the cardiac cycle, has emerged as a more precise myocardial function measure than left ventricular ejection fraction (LVEF). Longitudinal strain may be selectively affected in subclinical heart disease, even in the presence of normal LVEF. This study examines subclinical cardiac dysfunction, assessed by GLS and LVEF, and cognition among older adults.Methods and ResultsVanderbilt Memory and Aging Project participants who were free of clinical dementia, stroke, and heart failure (n=318, 73±7 years, 58% male) completed neuropsychological assessment and cardiac magnetic resonance to quantify GLS and LVEF. Linear regression models related GLS and LVEF to neuropsychological performances, adjusting for age, sex, race/ethnicity, education, Framingham Stroke Risk Profile, cognitive diagnosis, and APOE*ε4 status. Models were repeated with a cardiac×cognitive diagnosis interaction term. Compromised GLS (reflected by higher values) related to worse naming (β=−0.07, P=0.04), visuospatial immediate recall (β=−0.83, P=0.03), visuospatial delayed recall (β=−0.22, P=0.03), and verbal delayed recall (β=−0.11, P=0.007). LVEF did not relate to worse performance on any measure (P>0.18). No diagnostic interactions were observed.ConclusionsOur study results are among the first to suggest that compromised GLS relates to worse episodic memory and language performance among older adults who are free of clinical dementia, stroke, and heart failure. Subclinical cardiac dysfunction may correlate with cognitive health in late life, even when LVEF remains normal. The results add to growing evidence that GLS may be a more sensitive and preferred method for quantifying subclinical changes in cardiac function.

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Section: Discussionmentioning

confidence: 99%

Subclinical Compromise in Cardiac Strain Relates to Lower Cognitive Performances in Older Adults

Kresge

Khan

Wagener

et al. 2018

JAHA

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“…Pial collaterals have been recognized as a prognostic factor for favorable clinical outcome in ischemic stroke patients (Liebeskind 2003; McVerry et al. 2012), as they can temporarily compensate regional ischemia to a level that allows tissue survival (Astrup et al.…”

Section: Introductionmentioning

confidence: 99%

Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

et al. 2016

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PurposeClinically successful endovascular therapy (EVT) in ischemic stroke requires reliable noninvasive pretherapeutic selection criteria. We investigated the association of imaging parameters including CT angiographic collaterals and degree of reperfusion with clinical outcome after EVT.MethodsIn our database, we identified 93 patients with large vessel occlusion in the anterior circulation treated with EVT. Besides clinical data, we assessed the baseline Alberta Stroke Program Early CT score (ASPECTS) on noncontrast CT (NCCT) and CT angiography (CTA) source images, collaterals (CT‐CS) and clot burden score (CBS) on CTA and the degree of reperfusion after EVT on angiography. Three readers, blinded to clinical information, evaluated the images in consensus. Data‐driven multivariable ordinal regression analysis identified predictors of good outcome after 90 days as measured with the modified Rankin Scale.ResultsSuccessful angiographic reperfusion (OR 26.50; 95%‐CI 9.33–83.61) and good collaterals (OR 9.69; 95%‐CI 2.28–59.27) were independent predictors of favorable outcome along with female sex (OR 0.35; 95%‐CI 0.14–0.85), younger age (OR 0.88; 95%‐CI 0.83–0.92) and higher NCCT ASPECTS (OR 2.54; 95%‐CI 1.01–6.63). Outcome was best in patients with good collaterals and successful reperfusion, but there was no statistical interaction between collaterals and reperfusion.Conclusions CTA‐collateral status was the strongest pretherapeutic predictor of favorable outcome in ischemic stroke patients treated with EVT. CTA‐collaterals are thus well suited for patient selection in EVT. However, the independent effect of reperfusion on outcome tended to be stronger than that of CTA‐collaterals.

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“…In particular, clinical data suggest that collateral blood flow through the circle of Willis and anastomatic connections between the distal segments of cerebral arteries may facilitate partial reperfusion of ischemic territories after focal stroke (Liebeskind, 2003). Treatments that increase cerebral blood flow to ischemic regions through this collateral vasculature may therefore be neuroprotective (Liebeskind, 2005).…”

Section: Introductionmentioning

confidence: 99%

Laser Speckle Contrast Imaging of Collateral Blood Flow during Acute Ischemic Stroke

Armitage

Todd

Shuaib

et al. 2010

J Cereb Blood Flow Metab

113

102

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Collateral vasculature may provide an alternative route for blood flow to reach the ischemic tissue and partially maintain oxygen and nutrient support during ischemic stroke. However, much about the dynamics of stroke-induced collateralization remains unknown. In this study, we used laser speckle contrast imaging to map dynamic changes in collateral blood flow after middle cerebral artery occlusion in rats. We identified extensive anastomatic connections between the anterior and middle cerebral arteries that develop after vessel occlusion and persist for 24 hours. Augmenting blood flow through these persistent yet dynamic anastomatic connections may be an important but relatively unexplored avenue in stroke therapy.

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Collateral Circulation

Cited by 933 publications

References 55 publications

Subclinical Compromise in Cardiac Strain Relates to Lower Cognitive Performances in Older Adults

Subclinical Compromise in Cardiac Strain Relates to Lower Cognitive Performances in Older Adults

Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

Laser Speckle Contrast Imaging of Collateral Blood Flow during Acute Ischemic Stroke

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