Collateral Circulation in Ischemic Stroke

Bang, Oh Young; Goyal, Mayank; Liebeskind, David S

doi:10.1161/strokeaha.115.010508

Cited by 228 publications

(126 citation statements)

References 94 publications

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“…This suggests that there are other biological processes involved in the infarction mechanism, processes which are not captured by the DWI imaging modality. Here again, this is in accordance with the literature; notably, many studies recently showed the importance of collateral circulation in stroke [27]. …”

Section: Impact Of Noise On Tissue Fate Prediction Accuracysupporting

confidence: 92%

Multicomponent and Longitudinal Imaging Seen as a Communication Channel—An Application to Stroke

Giacalone

Frindel

Grenier

et al. 2017

Entropy

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Abstract:In longitudinal medical studies, multicomponent images of the tissues, acquired at a given stage of a disease, are used to provide information on the fate of the tissues. We propose a quantification of the predictive value of multicomponent images using information theory. To this end, we revisit the predictive information introduced for monodimensional time series and extend it to multicomponent images. The interest of this theoretical approach is illustrated on multicomponent magnetic resonance images acquired on stroke patients at acute and late stages, for which we propose an original and realistic model of noise together with a spatial encoding for the images. We address therefrom very practical questions such as the impact of noise on the predictability, the optimal choice of an observation scale and the predictability gain brought by the addition of imaging components.

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Section: Impact Of Noise On Tissue Fate Prediction Accuracysupporting

confidence: 92%

Multicomponent and Longitudinal Imaging Seen as a Communication Channel—An Application to Stroke

Giacalone

Frindel

Grenier

et al. 2017

Entropy

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“…Possible approaches to enhancing collateral flow include induced hypertension, volume expansion, external counterpulsation, temporary partial aortic obstruction, and stimulation of the sphenopalatine ganglion. 137 All of these approaches entail potential side effects that may adversely affect outcome, and some have inherent time delays. They could be considered for patients who will have long time delays before reaching the tertiary center for IA device therapy as was discussed for neuroprotective strategies to delay ischemic core expansion.…”

Section: Future Directionsmentioning

confidence: 99%

Acute Ischemic Stroke Therapy Overview

Catanese

Tarsia

Fisher

2017

Circulation Research

292

178

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A cute ischemic stroke (AIS) is a common disorder with almost 700 000 new or recurrent events per year in the United States. The risk of AIS varies by region, with the highest incidence occurring in the so-called stroke belt in the southern part of the country.1 The risk of AIS varies among African Americans, Latinos, and Caucasians, with the highest risk in African Americans. The risk of AIS increases with age, and the ageing of the US population portends an increase in AIS incidence and prevalence over the next several decades, despite increasingly effective efforts to treat stroke risk factors and the use of other preventive strategies.2 The incidence of AIS is also increasing in many other countries, largely related to potentially modifiable risk factors, especially in the developing world.3 The incidence of AIS is also greater among women beginning with an increased risk in the perimenopausal period and continuing into older age groups. Abstract: The treatment of acute ischemic stroke has undergone dramatic changes recently subsequent to the demonstrated efficacy of intra-arterial (IA) device-based therapy in multiple trials. The selection of patients for both intravenous and IA therapy is based on timely imaging with either computed tomography or magnetic resonance imaging, and if IA therapy is considered noninvasive, angiography with one of these modalities is necessary to document a large-vessel occlusion amenable for intervention. More advanced computed tomography and magnetic resonance imaging studies are available that can be used to identify a small ischemic core and ischemic penumbra, and this information will contribute increasingly in treatment decisions as the therapeutic time window is lengthened. Intravenous thrombolysis with tissue-type plasminogen activator remains the mainstay of acute stroke therapy within the initial 4.5 hours after stroke onset, despite the lack of Food and Drug Administration approval in the 3-to 4.5-hour time window. In patients with proximal, large-vessel occlusions, IA device-based treatment should be initiated in patients with small/moderate-sized ischemic cores who can be treated within 6 hours of stroke onset. The organization and implementation of regional stroke care systems will be needed to treat as many eligible patients as expeditiously as possible. Novel treatment paradigms can be envisioned combining neuroprotection with IA device treatment to potentially increase the number of patients who can be treated despite long transport times and to ameliorate the consequences of reperfusion injury. Acute stroke treatment has entered a golden age, and many additional advances can be anticipated. (Circ Res. 2017;120:541-558.

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“…However, previous studies have suggested that the degree of leptomeningeal collateral circulation (CC) may delay, or even prevent infarct progression [2]. Good CC has been associated with better clinical and functional outcomes [3], an increased recanalization rate [4], a lower rate of hemorrhagic transformation [5], and may extend the time window for endovascular procedures [2]. The rationale for these results is the ability of CC to maintain blood flow beyond the ischemic penumbra before recanalization is achieved, reducing the infarct core and making a good clinical outcome more likely [6].…”

Section: Introductionmentioning

confidence: 99%

Improving the Evaluation of Collateral Circulation by Multiphase Computed Tomography Angiography in Acute Stroke Patients Treated with Endovascular Reperfusion Therapies

García‐Tornel¹,

Carvalho

Boned³

et al. 2016

Intervent Neurol

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Good collateral circulation (CC) is associated with favorable outcomes in acute stroke, but the best technique to evaluate collaterals is controversial. Single-phase computed tomography angiography (sCTA) is widely used but lacks temporal resolution. We aim to compare CC evaluation by sCTA and multiphase CTA (mCTA) as predictors of outcome in endovascular treated patients. Methods: Consecutive endovascular treated patients with M1 middle cerebral artery (MCA) or terminal intracranial carotid artery (TICA) occlusion confirmed by sCTA were included. Two more CTA acquisitions with 8- and 16-second delays were performed for mCTA. Endovascular thrombectomy was performed independently of the CC status according to a local protocol [Alberta Stroke Program Early CT score (ASPECTS) >6, modified Rankin scale (mRS) score <3]. CC on sCTA and mCTA were compared. Results: 108 patients were included. Their mean age was 69.6 ± 13 years and their median National Institutes of Health Stroke Scale (NIHSS) score was 17 (interquartile range 8). 79 (73.1%) had M1 MCA and 29 (26.9%) TICA occlusions. The mean time from symptom onset to CTA was 146.8 ± 96.5 min. On sCTA, 50.9% patients presented good CC vs. 57.5% on mCTA. Good CC status in both sCTA and mCTA had a lower 24-hour infarct volume (27.4 vs. 74.8 cm³ on sCTA, p = 0.04; 17.2 vs. 97.8 cm³ on mCTA, p < 0.01). However, only good CC on mCTA was associated with lower 24-hour (5 vs. 8.5, p = 0.04) and median discharge NIHSS (2 vs. 4.5, p = 0.04) scores and functional independency (mRS score <3) at 3 months (76.9 vs. 23.1%, p < 0.01). In a logistic regression model including age, NIHSS, ASPECTS and recanalization, only age (OR 0.96, 95% CI 0.93-0.99, p = 0.02) and good CC on mCTA (OR 5, 95% CI 1.99-12.6, p < 0.01) were independent predictors of functional outcome at 3 months. Conclusion: CC evaluation by mCTA is a better prognostic marker than CC evaluation by sCTA for clinical and functional endpoints in acute stroke patients treated with endovascular thrombectomy.

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Collateral Circulation in Ischemic Stroke

Cited by 228 publications

References 94 publications

Multicomponent and Longitudinal Imaging Seen as a Communication Channel—An Application to Stroke

Multicomponent and Longitudinal Imaging Seen as a Communication Channel—An Application to Stroke

Acute Ischemic Stroke Therapy Overview

Improving the Evaluation of Collateral Circulation by Multiphase Computed Tomography Angiography in Acute Stroke Patients Treated with Endovascular Reperfusion Therapies

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