Impact of collateral flow on tissue fate in acute ischaemic stroke

Bang, Oh Young; Saver, Jeffrey L.; Buck, Brian; Alger, Jeffry R.; Starkman, Sidney; Ovbiagele, Bruce; Kim, Doojin; Jahan, Reza; Duckwiler, Gary; Yoon, Sa Rah; Viñuela, Fernando; Liebeskind, David S

doi:10.1136/jnnp.2007.132100

Cited by 346 publications

(323 citation statements)

References 12 publications

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“…The predictive value of the morphologic extent is consistent with previous reports using dynamic CTA and other imaging techniques. 4,14,26 Notably, both delay and extent remained independent predictors after correcting for IV thrombolysis and mechanical thrombectomy. This suggests the beneficial effect of good collateralization in dynamic CTA, even in the absence of interventions.…”

Section: Discussionmentioning

confidence: 96%

“…To our knowledge, this is the first study to quantitatively show a predictive value of the collateral blood flow delay independent of the morphologic collateral grade. Qualitative assessment of hemodynamic and morphologic parameters of leptomeningeal collaterals has been used in catheter angiography grading systems and has been shown to predict a favorable outcome, [24][25][26] showing the importance of enhancement time for collateral quality. Saito et al 27 assessed the correlation of transit time from the ICA to the M2 segment with the lesion size on follow-up NECT.…”

Section: Discussionmentioning

confidence: 99%

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Predictive Value of the Velocity of Collateral Filling in Patients with Acute Ischemic Stroke

Beyer¹,

Baumgarten

Thierfelder³

et al. 2014

J Cereb Blood Flow Metab

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The velocity of collateral filling can be assessed in dynamic time-resolved computed tomography (CT) angiographies and may predict initial CT perfusion (CTP) and follow-up lesion size. We included all patients with an M1 ± internal carotid artery (ICA) occlusion and follow-up imaging from an existing cohort of 1791 consecutive patients who underwent multimodal CT for suspected stroke. The velocity of collateral filling was quantified using the delay of time-to-peak (TTP) enhancement of the M2 segment distal to the occlusion. Cerebral blood volume (CBV) and mean transit time (MTT)-CBV mismatch were assessed in initial CTP. Follow-up lesion size was assessed by magnetic resonance imaging (MRI) or non-enhanced CT (NECT). Multivariate analyses were performed to adjust for extent of collateralization and type of treatment. Our study comprised 116 patients. Multivariate analysis showed a short collateral blood flow delay to be an independent predictor of a small CBV lesion (P o 0.001) and a large relative mismatch (P o 0.001) on initial CTP, of a small follow-up lesion (P o 0.001), and of a small difference between initial CBV and follow-up lesion size (P = 0.024). Other independent predictors of a small lesion on follow-up were a high morphologic collateral grade (P = 0.001), lack of an additional ICA occlusion (P = 0.009), and intravenous thrombolysis (P = 0.022). Fast filling of collaterals predicts initial CTP and follow-up lesion size and is independent of extent of collateralization.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Predictive Value of the Velocity of Collateral Filling in Patients with Acute Ischemic Stroke

Beyer¹,

Baumgarten

Thierfelder³

et al. 2014

J Cereb Blood Flow Metab

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“…Besides lysis of the obstruction, thrombolytics also reverse stasis-induced thrombosis distal to the occlusion. However, access depends on the extent of the pial collateral circulation (Brozici et al, 2003;Liebeskind, 2005), yet patients with acute occlusion evidence wide variation in the extent of retrograde perfusion of the MCA tree (Bang et al, 2008;Christoforidis et al, 2009). Whether this is due to individual variation in the pial collateral circulation or thrombotic or other mechanisms is unclear because current imaging methods cannot resolve these small vessels in humans, and until now, no animal studies had been done.…”

Section: Discussionmentioning

confidence: 99%

“…Retrograde perfusion of the distal MCA in patients suffering acute obstruction of its trunk varies substantially (Bang et al, 2008;Christoforidis et al, 2009), presumably in part from differences in the extent of the preexisting pial collateral circulation. The contribution of genetic differences to such variation is unknown.…”

Section: Wide Genetic Variation In the Extent Of The Native Pial Collmentioning

confidence: 99%

Wide Genetic Variation in the Native Pial Collateral Circulation is a Major Determinant of Variation in Severity of Stroke

Zhang

Prabhakar

Sealock

et al. 2010

J Cereb Blood Flow Metab

228

383

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Severity of stroke varies widely among individuals. Whether differences in the extent of the native (preexisting) pial collateral circulation exist and contribute to this variability is unknown. We addressed these questions and probed for potential genetic contributions using morphometric analysis of the collateral circulation in 15 inbred mouse strains recently shown to exhibit wide differences in infarct volume. Morphometrics were determined in the unligated left hemisphere (for native collaterals) and ligated right hemisphere (for remodeled collaterals) 6 days after permanent middle cerebral artery (MCA) occlusion. Variation among strains in native collateral number, diameter, MCA, anterior cerebral artery (ACA), and posterior cerebral artery (PCA) tree territories were, respectively: 56-fold, 3-fold, 42%, 56%, and 61%. Collateral length (P < 0.001) and the number of penetrating arterioles branching from them also varied (P < 0.05). Infarct volume correlated inversely with collateral number (P < 0.0001), diameter (P < 0.0001), and penetrating arteriole number (P < 0.05) and directly with MCA territory (P < 0.05). Relative collateral conductance and MCA territory, when factored together, strongly predicted infarct volume (P < 0.0001). Outward remodeling of collaterals in the ligated hemisphere varied B3-fold. These data show that the extent of the native pial collateral circulation and collateral remodeling after obstruction vary widely with genetic background, and suggest that this variability, due to natural polymorphisms, is a major contributor to variability in infarct volume.

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“…Clinical data were prospectively collected on a web-based registry, including demographic data, symptoms onset, time of arrival at the Emergency Department, acute phase parameters, blood examination, National Institute of Health Stroke Scale (NIHSS) astreatment (ET) is a key element to achieve a favourable outcome. In the acute pre-treatment phase of ischaemic stroke, collateral circulation allows the complete or partial perfusion of the ischaemic area beyond the clot, and contributes to the survival of the ischaemic penumbra 4 . Some authors found that pial collateral circulation at digital subtraction angiography was correlated with the reduction of the infarcted area in 36 patients with middle cerebral artery (MCA) occlusion 5 and that good collateral circulation resulted in less severe neurological deficits at baseline 6 .…”

Section: Methodsmentioning

confidence: 99%

Effect of the Interaction between Recanalization and Collateral Circulation on Functional Outcome in Acute Ischaemic Stroke

et al. 2014

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Identification of patients with acute ischaemic stroke who could most benefit from arterial recanalization after endovascular treatment remains an unsettled issue. Although several classifications of collateral circulation have been proposed, the clinical role of collaterals is still debated. We evaluated the effect of the collateral circulation in relation to recanalization as a predictor of clinical outcome. Data were prospectively collected from 103 patients consecutively treated for proximal middle cerebral or internal carotid artery occlusion. The collateral circulation was evaluated with a novel semiquantitative-qualitative score, the Careggi collateral score (CCS), in six grades. Both CCS and recanalization grades (TICI) were analysed in relation to clinical outcome. A statistical analysis was performed to evaluate the effect of interaction between recanalization and collateral circulation on clinical outcome. Out of the 103 patients, 37 (36.3%) had poor collaterals, and 65 (63.7%) had good collaterals. Patients with good collaterals had lower basal National Institute of Health Stroke Scale (NIHSS), more distal occlusion, smaller lesions at 24h CT scan and better functional outcome. After multivariate analysis, the interaction between recanalization and collateral grades was significantly stronger as a predictor of good outcome (OR 6.87, 95% CI 2.11–22.31) or death (OR 4.66, 95% CI 1.48–14.73) compared to the effect of the single variables. Collaterals showed an effect of interaction with the recanalization grade in determining a favourable clinical outcome. Assessment of the collateral circulation might help predict clinical results after recanalization in patients undergoing endovascular treatment for acute ischaemic stroke.

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Impact of collateral flow on tissue fate in acute ischaemic stroke

Abstract: Background-Collaterals may sustain penumbra prior to recanalisation yet the influence of baseline collateral flow on infarct growth following endovascular therapy remains unknown.

Cited by 346 publications

References 12 publications

Predictive Value of the Velocity of Collateral Filling in Patients with Acute Ischemic Stroke

Predictive Value of the Velocity of Collateral Filling in Patients with Acute Ischemic Stroke

Wide Genetic Variation in the Native Pial Collateral Circulation is a Major Determinant of Variation in Severity of Stroke

Effect of the Interaction between Recanalization and Collateral Circulation on Functional Outcome in Acute Ischaemic Stroke

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