Cerebral Collateral Circulation – Potential Target for Cerebral Infarction Management

Czech version

Authors: O. Volný ^1–3; R. Mikulík ^1,3
Authors‘ workplace: Mezinárodní centrum klinického výzkumu (ICRC), Brno ¹; Anatomický ústav LF MU, Brno ²; I. neurologická klinika LF MU a FN u sv. Anny v Brně ³
Published in: Cesk Slov Neurol N 2013; 76/109(3): 307-314
Category: Review Article

Overview

Leptomeningeal (pial) collaterals are native anastomoses that cross- connect the distal- most arterioles within the branches of the main cerebral arteries. They represent a potential emergency backdoor to maintain blood flow to the brain during an acute ischemic stroke. In addition, support of collateral circulation represents an attractive concept of stroke therapy. So far, neurologists mostly paid attention to recanalization therapies but neglected cerebral collateral circulation as a therapeutic target. This theme is very topical not only for cerebrovascular neurologists. The purpose of this article is to summarize information on a) anatomy and (patho)physiology of cerebral collateral circulation, b) diagnostics of collateral circulation including scoring systems using widely- available CT angiography, and c) pharmacological and non‑pharmacological therapies aimed at augmenting cerebral collateral circulation.

Key words:
stroke – collateral circulation – reperfusion – induced hypertension

Sources

1. Fields JD, Lutsep HL, Smith WS. MERCI Multi MERCI Investigators. Higher degrees of recanalization after mechanical thrombectomy for acute stroke are associated with improved outcome and decreased mortality: pooled analysis of the MERCI and Multi MERCI trials. AJNR Am J Neuroradiol 2011; 32(11): 2170– 2174.

2. Kang DH, Hwang YH, Kim YS, Park J, Kwon O, Jung C. Direct thrombus retrieval using the reperfusion catheter of the penumbra system: forced- suction thrombectomy in acute ischemic stroke. AJNR Am J Neuroradiol 2011; 32(2): 283– 287.

3. Feng W, Vasquez G, Suri MF, Lakshminarayan K, Qureshi AI. Repeated- measures analysis of the National Institute of Neurological Disorders and Stroke rt- PA stroke trial. J Stroke Cerebrovasc Dis 2011; 20(3): 241– 246.

4. Smith WS. Safety of mechanical thrombectomy and intravenous tissue plasminogen activator in acute ischemic stroke. Results of the multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trial, part I. AJNR Am J Neuroradiol 2006; 27(6): 1177– 1182.

5. Mikulik R, Ribo M, Hill MD, Grotta JC, Malkoff M, Molina C et al. Accuracy of serial National Institutes of Health Stroke Scale scores to identify artery status in acute ischemic stroke. Circulation 2007; 115(20): 2660– 2665.

6. Lima FO, Furie KL, Silva GS, Lev MH, Camargo EC,Singhal AB et al. The pattern of leptomeningeal collaterals on CT angiography is a strong predictor of long‑term functional outcome in stroke patients with large vessel intracranial occlusion. Stroke 2010; 41(10): 2316– 2322.

7. Liebeskind DS. Collateral circulation. Stroke 2003; 34(9): 2279– 2284.

8. Schramm P, Schellinger PD, Fiebach JB, Heiland S, Jansen O, Knauth M et al. Comparison of CT and CT angiography source images with diffusion- weighted imaging in patients with acute stroke within 6 hours after onset. Stroke 2002; 33(10): 2426– 2432.

9. Rosenthal ES, Schwamm LH, Roccatagliata L, Coutts SB, Demchuk AM, Schaefer PW et al. Role of recanalization in acute stroke outcome: rationale for a CT angiogram‑based „benefit of recanalization“ model. AJNR Am J Neuroradiol 2008; 29(8): 1471– 1475.

10. Tan IY, Demchuk AM, Hopyan J, Zhang L, Gladstone D, Wong K et al. CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. AJNR Am J Neuroradiol 2009; 30(3): 525– 531.

11. Menon BK, Smith EE, Modi J, Patel SK, Bhatia R, Watson TW et al. Regional leptomeningeal score on CT angiography predicts clinical and imaging outcomes in patients with acute anterior circulation occlusions. AJNR Am J Neuroradiol 2011; 32(9): 1640– 1645.

12. Bang OY, Saver JL, Buck BH, Alger JR, Starkman S,Ovbiagele B et al. Impact of collateral flow on tissue fate in acute ischaemic stroke. J Neurol Neurosurg Psychiatry 2008; 79(6): 625– 629.

13. Riedel CH, Zimmermann P, Jensen- Kondering U, Stingele R, Deuschl G, Jansen O. The importance of size: successful recanalization by intravenous thrombolysis in acute anterior stroke depends on thrombus length. Stroke 2011; 42(6): 1775– 1777.

14. Bang OY, Saver JL, Kim SJ, Kim GM, Chung CS, Ovbiagele B et al. Collateral flow predicts response to endovascular therapy for acute ischemic stroke. Stroke 2011; 42(3): 693– 699.

15. Tissue plasminogen activator for acute ischemic stroke. The national institute of neurological disorders and stroke rt- pa stroke study group. N Engl J Med 1995; 333(24): 1581– 1587.

16. Kim YS, Meyer JS, Garami Z, Molina CA, Pavlovic AM, Alexandrov AV. Flow diversion in transcranial Doppler ultrasound is associated with better improvement in patients with acute middle cerebral artery occlusion. Cerebrovasc Dis 2006; 21(1– 2): 74– 78.

17. Maas MB, Lev MH, Ay H, Singhal AB, Greer DM, Smith WS et al. Collateral vessels on CT angiography predict outcome in acute ischemic stroke. Stroke 2009; 40(9): 3001– 3005.

18. Shuaib A, Butcher K, Mohammad AA, Saqqur M, Liebeskind DS. Collateral blood vessels in acute ischaemic stroke: a potential therapeutic target. Lancet Neurol 2011; 10(10): 909– 921.

19. Tilley BC, Marler J, Geller NL, Lu M, Legler J, Brott Tet al. Use of a global test for multiple outcomes in stroke trials with application to the National Institute of Neurological Disorders and Stroke t- PA Stroke Trial. Stroke 1996; 27(11): 2136– 2142.

20. Suzuki N, Hardebo JE, Kahrström J, Owman C. Selective electrical stimulation of postganglionic cerebrovascular parasympathetic nerve fibers originating from the sphenopalatine ganglion enhances cortical blood flow in the rat. J Cereb Blood Flow Metab 1990; 10(3): 383– 391.

21. Han JH, Wong KS. Is counterpulsation a potential therapy for ischemic stroke? Cerebrovasc Dis 2008; 26(2): 97– 105.

22. Pranevicius M, Pranevicius O. Cerebral venous steal: blood flow diversion with increased tissue pressure. Neurosurgery 2002; 51(5): 1267– 1273.

23. Aries MJ, Bakker DC, Stewart RE, De Keyser J, Elting JW, Thien T et al. Exaggerated postural blood pressure rise is related to a favorable outcome in patients with acute ischemic stroke. Stroke 2012; 43(1): 92– 96.

24. Wojner- Alexander AW, Garami Z, Chernyshev OY,Alexandrov AV. Heads down: flat positioning improves blood flow velocity in acute ischemic stroke. Neurology 2005; 64(8): 1354– 1357.

25. Shin HK, Nishimura M, Jones PB, Ay H, Boas DA, Moskowitz MA et al. Mild induced hypertension improves blood flow and oxygen metabolism in transient focal cerebral ischemia. Stroke 2008; 39(5): 1548– 1555.

26. Cordina SM, Majidi S, Chaudhry SA, Hassan AE,Rodriguez GJ, Qureshi AI et al. Safety of Induced Hypertension in Acute Ischemic Stroke Patients with Suboptimal Recanalization after Endovascular Thrombolysis. Stroke 2012; Abstract 3086.