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Review
. 2023 Jul 20;13(14):2425.
doi: 10.3390/diagnostics13142425.

The Pathophysiology of Collateral Circulation in Acute Ischemic Stroke

Marilena Mangiardi  1 , Adriano Bonura  2 , Gianmarco Iaccarino  2 , Michele Alessiani  2 , Maria Cristina Bravi  2 , Domenica Crupi  2 , Francesca Romana Pezzella  2 , Sebastiano Fabiano  3 , Enrico Pampana  3 , Francesco Stilo  4 , Guido Alfano  5 , Sabrina Anticoli  2
Affiliations
Review

The Pathophysiology of Collateral Circulation in Acute Ischemic Stroke

Marilena Mangiardi et al. Diagnostics (Basel). .

Abstract

Cerebral collateral circulation is a network of blood vessels which stabilizes blood flow and maintains cerebral perfusion whenever the main arteries fail to provide an adequate blood supply, as happens in ischemic stroke. These arterial networks are able to divert blood flow to hypoperfused cerebral areas. The extent of the collateral circulation determines the volume of the salvageable tissue, the so-called "penumbra". Clinically, this is associated with greater efficacy of reperfusion therapies (thrombolysis and thrombectomy) in terms of better short- and long-term functional outcomes, lower incidence of hemorrhagic transformation and of malignant oedema, and smaller cerebral infarctions. Recent advancements in brain imaging techniques (CT and MRI) allow us to study these anastomotic networks in detail and increase the likelihood of making effective therapeutic choices. In this narrative review we will investigate the pathophysiology, the clinical aspects, and the possible diagnostic and therapeutic role of collateral circulation in acute ischemic stroke.

Keywords: acute ischemic stroke; anterior brain circulation; collateral circulations; intravenous thrombolysis; penumbra; posterior brain circulation; thrombectomy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Brain CT-scan perfusion analyzed with rapid software in a patient with acute ischemic stroke show a favorable mismatch core (pink circle) vs. penumbra (green circle) with the following parameters: CBF < 30% volume: 15 mL; Tmax > 6.0 s volume: 160 mL; mismatch volume: 145 mL; mismatch ratio: 10, 6.
Figure 2
Figure 2
Core-penumbra ratio under different collateral circles condition. (A) Good collateral circles result in a large core-penumbra mismatch. (B) Poor collateral circles lead to a big core with small core-penumbra mismatch.
Figure 3
Figure 3
Automatic evaluation of collateral circles by ColorViz (A) and e-CTA (B) (reproduced under the terms and conditions of the Creative Commons Attribution (CC BY) license from Verzolotti et al. (A) and Zelenak et al. (B)). Corresponding acute ischemic lesion in the area supplied by the right middle cerebral artery in DWI sequences (red arrow (C)) and ADC sequences (red arrow (D)).
See this image and copyright information in PMC

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