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. 2017 Dec;37(12):3818-3823.
doi: 10.1177/0271678X17732695. Epub 2017 Sep 19.

Recanalization, reperfusion, and recirculation in stroke

John H Zhang  1 , Andre Obenaus  1 , David S Liebeskind  2 , Jiping Tang  1 , Richard Hartman  1 , William J Pearce  1
Affiliations

Recanalization, reperfusion, and recirculation in stroke

John H Zhang et al. J Cereb Blood Flow Metab. 2017 Dec.

Abstract

Recirculation, from arterial inflow routes through venous outflow pathways, was conceptualized in stroke research 50 years ago. As new technologies were developed, blocked arteries could be reopened, capillaries could be reperfused, and the use of recanalization and reperfusion grew to dominate therapeutic strategies. These approaches overwhelmingly focused on restoration of arterial and capillary inflow, but not on veins even though venous disorders may initiate or exacerbate brain injury. In this commentary, we advance the term "recirculation" after "recanalization" and "reperfusion" as a primary concept of stroke pathophysiology that targets the restoration of both the arterial and venous cerebral circulations.

Keywords: Recanalization; recirculation; reperfusion; stroke pathophysiology; stroke treatment.

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Figures

Figure 1.
Figure 1.
In patients with brain swelling and venous sinus narrowing, administration of Nimodipine may aggravate brain swelling. Nimodipine dilates artery but does not increase venous blood flow directly, because there are few smooth muscle cells in veins. Pericytes are also involved in venous flow. EC: endothelial cell; SM: smooth muscle.
Figure 2.
Figure 2.
Smooth muscle phenotype may change after a stroke and leads to loss of autoregulation. Venous endothelial cells can undergo phenotypic changes that promote venous thrombosis formation. In addition, pericytes are also involved in venous flow.
See this image and copyright information in PMC

References

    1. Bai J, Lyden PD. Revisiting cerebral postischemic reperfusion injury: new insights in understanding reperfusion failure, hemorrhage, and edema. Int J Stroke 2015; 10: 143–152. - PubMed
    1. Li Q, Khatibi N, Zhang JH. Vascular neural network: the importance of vein drainage in stroke. Transl Stroke Res 2014; 5: 163–166. - PMC - PubMed
    1. Zhang S, Lai Y, Ding X, et al. Absent filling of ipsilateral superficial middle cerebral vein is associated with poor outcome after reperfusion therapy. Stroke 2017; 48: 907–914. - PMC - PubMed
    1. Zimmermann V, Hossmann KA. Resuscitation of the monkey brain after one hour's complete ischemia. II. Brain water and electrolytes. Brain Res 1975; 85: 1–11. - PubMed
    1. Glower DD, Spratt JA, Snow ND, et al. Linearity of the Frank-Starling relationship in the intact heart: the concept of preload recruitable stroke work. Circulation 1985; 71: 994–1009. - PubMed