Rethinking the Collateral Vasculature Assessment in Acute Ischemic Stroke

TY - JOUR

T1 - Rethinking the Collateral Vasculature Assessment in Acute Ischemic Stroke

T2 - The Comprehensive Collateral Cascade

AU - Faizy, Tobias Djamsched

AU - Heit, Jeremy Josef

N1 - Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

PY - 2021/8/1

Y1 - 2021/8/1

N2 - Occlusion of a cervical or cerebral artery results in disruption of blood flow to the brain and may result in irreversible infarction. Intracranial pial collaterals are a network of arteries that may preserve blood flow to otherwise critically hypoperfused brain areas until vessel recanalization is achieved. The robustness of these arterial collaterals is pivotal for the survivability of ischemic brain tissue and is associated with treatment success and long-term clinical outcome. More recently, the importance of venous outflow from ischemic brain tissue has been appreciated. Arterial collaterals and venous outflow are evaluated by neuroimaging parameters, and recent imaging advances have enabled a more comprehensive assessment of the entire collateral cascade in patients with acute ischemic stroke. Here we review novel imaging biomarkers for the assessment of arterial collaterals, tissue-level collateral blood flow, and venous outflow. We also summarize how a more comprehensive assessment of the cerebral blood flow leads to a better prediction of treatment efficacy and improved clinical outcomes.

AB - Occlusion of a cervical or cerebral artery results in disruption of blood flow to the brain and may result in irreversible infarction. Intracranial pial collaterals are a network of arteries that may preserve blood flow to otherwise critically hypoperfused brain areas until vessel recanalization is achieved. The robustness of these arterial collaterals is pivotal for the survivability of ischemic brain tissue and is associated with treatment success and long-term clinical outcome. More recently, the importance of venous outflow from ischemic brain tissue has been appreciated. Arterial collaterals and venous outflow are evaluated by neuroimaging parameters, and recent imaging advances have enabled a more comprehensive assessment of the entire collateral cascade in patients with acute ischemic stroke. Here we review novel imaging biomarkers for the assessment of arterial collaterals, tissue-level collateral blood flow, and venous outflow. We also summarize how a more comprehensive assessment of the cerebral blood flow leads to a better prediction of treatment efficacy and improved clinical outcomes.

KW - Brain Ischemia/diagnostic imaging

KW - Collateral Circulation

KW - Humans

KW - Ischemic Stroke

KW - Neuroimaging

U2 - 10.1097/RMR.0000000000000274

DO - 10.1097/RMR.0000000000000274

M3 - SCORING: Review article

C2 - 34397967

VL - 30

SP - 181

EP - 186

JO - Topics in magnetic resonance imaging : TMRI

JF - Topics in magnetic resonance imaging : TMRI

SN - 0899-3459

IS - 4

ER -